Chiropractic Care

Overview  

Chiropractic care focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. It is commonly used to treat neuro-musculoskeletal complaints such as back pain, neck pain, headaches and joint pain. Chiropractors utilize a drug-free, hands-on approach to health care that includes patient examination, diagnosis and treatment.  

The most common therapeutic procedure is spinal manipulation, which restores joint mobility through controlled force applied to joints restricted by tissue injury. This alleviates pain and muscle tightness and promotes healing. 

Original Medicare Coverage 

I. Medicare-Covered Chiropractic Services 

Covered CPT Codes:

• 98940 – Spinal, 1–2 regions 
• 98941 – Spinal, 3–4 regions 
• 98942 – Spinal, 5 regions 

Required Modifier:

• AT Modifier – Must be appended to CPT codes to indicate a Medicare-covered visit.

- Do not use for routine care visits.

Note: All services must follow CMS Medicare coverage and coding guidelines. 

II. Routine Chiropractic Services 

Routine services include manipulations and procedures for wellness or maintenance care, which are not covered by Original Medicare.

Routine CPT Codes: 

• 98940, 98941, 98942 – Spinal manipulations (non-Medicare indications) 
• 98943 – Extraspinal manipulations 

Modifier Guidance: 

• AT Modifier – Should not be used on routine chiropractic claims. 

III. Common Routine Chiropractic Procedure Codes (Not a complete list) 

These codes are commonly used in routine care and are not considered covered by Medicare unless specified: 

• Therapeutic Procedures:
  • 97110 – Therapeutic exercise (15 minutes)
  • 97112 – Neuromuscular re-education
  • 97140 – Manual therapy techniques (e.g., myofascial release; 15 minutes)
• Radiology Services:
  • 72010 – Spine, entire, survey study, A-P and lateral
  • 72040 – Spine, cervical (2 or 3 views)
  • 72070 – Spine, thoracic (2 views)
  • 72100 – Spine, lumbosacral (2 or 3 views)
• Office Visit Services:
  • 99213 – Office visit, evaluation and management, established 20 minutes
  • 99214 – Office visit, evaluation and management, established 30 minutes
  • 99202 – Office visit, evaluation and management, new 15 minutes
  • 99203 – Office visit, evaluation and management, new 30 minutes

IV. Blue Cross and Blue Shield of Nebraska Medicare Advantage Enhanced Benefit 

The BCBSNE MedicareAdvantage plans provide at least the same  coverage as Original Medicare  and may include enhanced benefits.  

Routine Chiropractic Care Coverage Includes: 

• Routine visits are covered with a $20 copay per visit. 
• One set of diagnostic x-rays (up to three views) performed by a chiropractor annually at no cost to the member. 

Coverage scope, reimbursement methodology, payment limits, and member cost-sharing are determined by BCBSNE. 

V. Compliance Requirements 

All chiropractic services must be: 

• Medically necessary 
• Properly documented 
• Accurately coded 

Claims with incorrect modifiers or unsupported diagnoses may be denied or audited.