Medicare Coverage For Chiropractic Manipulative Treatment 
                     Medicare 
Coverag
e For 
Chiropra
ctic 
Manipula
tive 
Treatme
nt (CMT)
INTRODUCTION
Chiropractic Manipulative Treatment (CMT) is a 
form of manual treatment to influence joint and 
neurophysiological function. This treatment may 
be accomplished using a variety of techniques. 
Medicare covers limited chiropractic services 
when performed by a chiropractor who is licensed 
or legally authorized to furnish chiropractic 
services by the State or jurisdiction in which the 
services are furnished. For eligibility as a 
chiropractor, you can refer, “CMS Publication 100-
01, Medicare General Information, Eligibility and 
Entitlement Manual, Chapter 5, Section 70.6”. A 
chiropractor must also meet uniform minimum 
standards as set forth in the CMS Internet-Only 
Manual (IOM). In this article, we shared coding 
guidelines and Medicare coverage for 
Chiropractic Manipulative Treatment (CMT).
https://www.medisysdata.com/blog/medicare-cov
erage-for-chiropractic-manipulative-treatment-cm
t/
             Medicare 
Coverage
● The patient must have a significant health problem in 
the form of a neuromusculoskeletal condition 
necessitating treatment, and the manipulative 
services rendered must have a direct therapeutic 
relationship to the patient’s condition and provide 
reasonable expectation of recovery or improvement of 
function.
●  The patient must have a subluxation of the spine as 
demonstrated by x-ray or physical exam. Most spinal 
joint problems fall into the categories acute 
subluxation and chronic subluxation.
https://www.medisysdata.com/blog/medicare-coverage-for-chiropractic-
manipulative-treatment-cmt/
● For Medicare purposes, a chiropractor 
must place an AT modifier on a claim when 
providing active/corrective treatment to 
treat acute or chronic subluxation. 
● However, the presence of the AT modifier 
may not in all instances indicate that the 
service is reasonable and necessary. As 
always, contractors may deny if 
appropriate after medical review.
●  Modifier AT must only be used when the 
chiropractic manipulation is “reasonable 
and necessary” as defined by national 
policy. 
● Modifier AT must not be used when 
maintenance therapy has been performed. 
The need for a prolonged course of 
treatment should be appropriate to the 
reported procedure code(s) and medical 
necessity must be documented clearly in 
the medical record.
     
https://www.medisysdata.com/blog/medicare-cover
age-for-chiropractic-manipulative-treatment-cmt/
● The precise level of the subluxation must be 
listed.
● The date of the initial treatment or date of 
exacCerobadtioin ogf  thGe uexiidstiengl icnonedistion must 
be entered in Item 14 of the CMS-1500 form 
or the electronic equivalent.
● If using an x-ray as documentation of the 
subluxation, the date of the x-ray (or existing 
MRI or CT scan) must be entered in Item 19 of 
the CMS-1500 form or the electronic 
equivalent.
● If an authorized ordering practitioner orders 
the x-ray, then he/she should enter his/her 
name in Item 17 of the CMS-1500 form and 
his/her own NPI number in Item 17a of the 
CMS-1500 form, or the electronic equivalent, 
as the ordering physician.
https://www.medisysdata.com/blog/denial-anal
ysis-in-medical-billing-for-higher-reimbursemen
t/
Coding 
Guidelines
● The HCPCS modifier AT (acute treatment) must be 
appended to the chiropractic manipulation code to 
indicate the manipulation was for medically 
necessary and reasonable treatment of an acute 
subluxation or chronic subluxation as defined in 
national policy and the LCD.
● The AT modifier must not be placed on the claim 
when maintenance therapy has been provided. 
Claims without the AT modifier will be considered 
as maintenance therapy and denied.
● For claims submitted to the Part B MAC: All 
services/procedures performed on the same day 
for the same beneficiary by the physician/provider 
should be billed on the same claim.
● Procedure codes 98940; 98941; and 98942 
Chiropractic manipulative treatment: Spinal; 1-
2/3-4; 5 regions) are used to bill chiropractic 
manipulative treatment.
https://www.medisysdata.com/blog/medicare-coverag
e-for-chiropractic-manipulative-treatment-cmt/
About Us
      Medisys Data Solutions is a leading 
medical billing company providing 
complete assistance in medical billing and 
coding. We can assist you in receiving 
accurate insurance reimbursement from 
private and government payers. With our 
services like benefits verification and 
credentialing & enrollment, you can add 
more providers in your practice. To know 
more about our specialty specific medical 
billing and coding services, contact us at 
info@medisysdata.com/ 302-261-9187.
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