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    v1.0.28
    OpenPayerPolicy UpdatesReimbursement/Payment PolicySendero Chiropractic Coverage Update | OpenPayer
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    CurrentSendero Health PlansPolicy NM-UPDATE1119

    Billing for Chiropractic Services

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    This policy governs coverage and billing for chiropractic services under Sendero IdealCare. Covered services are limited to spinal manipulations and adjustments identified by specified CPT codes.

    Policy Summary
    PayerSendero Health Plans
    PolicyBilling for Chiropractic Services
    Policy CodePolicy NM-UPDATE1119
    Change TypeNo material change
    Effective DateNov 1, 2019
    Next Review DateNot specified
    Key ActionBill covered chiropractic services only when they consist of spinal manipulations or adjustments and are reported with CPT codes 98940, 98941, or 98942.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    3Covered CPT codes
    Spinal manipulation onlyCovered service scope

    Covered Chiropractic Services

    Covered chiropractic services

    Covered when the service consists of a spinal manipulation or adjustment and is reported with a specified CPT code.

    ALL of the following

    • Service type

      • The chiropractic service is a spinal manipulation or adjustment.
    • One of the following CPT codes

      • CPT code 98940 is reported.
      • CPT code 98941 is reported.
      • CPT code 98942 is reported.
    Policy Summary
    PayerSendero Health Plans
    PolicyBilling for Chiropractic Services
    Policy CodePolicy NM-UPDATE1119
    Change TypeNo material change
    Effective DateNov 1, 2019
    Next Review DateNot specified
    Key ActionBill covered chiropractic services only when they consist of spinal manipulations or adjustments and are reported with CPT codes 98940, 98941, or 98942.
    SourceLink
    On This Page
    Covered Chiropractic ServicesCovered CPT CodesBilling Requirements

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Covered CPT Codes

    Covered CPT CodesCPTCovered
    98940Covered chiropractic service
    98941Covered chiropractic service
    98942Covered chiropractic service

    Billing Requirements

    Billing Rule

    Submit only specified covered chiropractic services

    Bill covered chiropractic services only when they consist of spinal manipulations or adjustments and are reported with CPT codes 98940, 98941, or 98942.

    • Covered services are limited to spinal manipulations and adjustments.
    • Report only CPT codes 98940, 98941, or 98942.