Chiropractic and osteopathic manipulation are manual therapies used for the diagnosis and treatment of musculoskeletal dysfunction. Chiropractic care is described as a system of complementary medicine based on diagnosis and manipulative treatment of joint misalignments, while osteopathy views the body as an interconnected whole and uses manual methods to address somatic dysfunction and related disorders. (See CPT guidance and policy descriptions for scope and purpose.)
For Chiropractic Manipulative Treatment (CMT), the CPT codes 98940–98942 correspond to the number of spinal regions treated: 98940 = spinal, 1–2 regions; 98941 = spinal, 3–4 regions; 98942 = spinal, 5 regions. Documentation must specify the problem/complaint and the precise level of each subluxation treated; the specific subluxation level(s) must be listed as the primary diagnosis on the claim and spinal areas should be documented separately (for example, cervical, thoracic, lumbar, sacrum, pelvic and vertebral levels C1–S5). Generic phrases such as “all spinal regions” do not meet the required specificity.
For Osteopathic Manipulative Treatment (OMT), areas of treatment are identified by named regions and extremities. Examples include head, sacral, cervical, pelvic, thoracic, lumbar, rib cage, abdomen/viscera, and upper and lower extremities (with bilateral extremities counted as one region). Documentation for OMT must name the region(s) treated, document somatic dysfunction, describe techniques used and patient tolerance, and record functional improvement or decline when patients are seen repeatedly.
The CPT manual treats CMT codes as minor procedures that include an inherent evaluation-and-management (E/M) component. The RVU for these services reflects pre-service, intra-service and post-service work, so routine pre/intra/post-procedure E/M care included with the procedure is not reportable separately. An E/M service may be reported with modifier 25 only when the E/M represents significant, separately identifiable work beyond the usual associated care; documentation must clearly support that separate E/M work was performed.
When providing active or corrective chiropractic treatment for acute or chronic subluxation, providers must append modifier AT to CMT claims. Maintenance therapy—ongoing care when further improvement cannot be expected—is considered not medically necessary and modifier AT must not be used for maintenance services.