Which Common Chiropractic CPT Codes Cause the Most Denials?

The most common chiropractic CPT codes are 98940, 98941, and 98942 for Chiropractic Manipulative Treatment (CMT). Chiropractors also frequently bill evaluation and management (E/M) codes, therapeutic procedure codes, and diagnostic imaging codes when medically necessary. Selecting the correct CPT code, supporting it with proper documentation, and following payer guidelines are essential for accurate reimbursement and reducing claim denials.

The following are a few of the codes that chiropractors frequently use: 

98940: Chiropractic Manipulative Treatment (CMT) for 1–2 spinal regions

98941: Chiropractic Manipulative Treatment (CMT) for 3–4 spinal regions

98942: Chiropractic Manipulative Treatment (CMT) for 5 spinal regions

98943: Chiropractic Manipulative Treatment for extraspinal regions such as shoulders, hips, knees, wrists, or ankles

99202–99205: Evaluation and Management (E/M) services for new patients

99211–99215: Evaluation and Management (E/M) services for established patients

97110: Therapeutic Exercises

97112: Neuromuscular Re-education

Top chiropractic CPT codes causing the denials

The chiropractic CPT codes responsible for causing the most denials are spinal CMT, Extraspinal CMT, Therapeutic Exercise, Manual Therapy and modifier misuse.  However, the Centres for Medicare & Medicaid Services, the biggest cause behind CPT code causing the denial is wrong documentation. Another survey by the U.S. Department of Health and Human Services Office of Inspector General (OIG) found that Evaluation and Management (E/M) codes are among the most commonly incorrectly coded medical billing codes. The review showed that 42% of E/M claims were incorrectly coded. 

Let’s explore each chiropractic CPT code causing the denial:

1. CPT 98943 – Extraspinal Manipulation

CPT 98943 covers chiropractic manipulation of extraspinal joints such as the shoulder, elbow, wrist, hip, knee, ankle, or jaw. This CPT code for chiropractic frequently causes denials because many insurance companies have limited coverage policies, and Medicare generally does not reimburse CPT 98943.

Common denial reasons include:

• Service not covered by the payer.
• Missing medical necessity documentation.
• Incorrect payer selection.
• Billing extra-spinal manipulation without verifying coverage.

Precaution: Practices should always review payer-specific guidelines before billing this code.

2. CPT 98940, 98941 & 98942 – Chiropractic Manipulative Treatment (CMT)

These are the most commonly billed chiropractic CPT codes and also the most frequently denied.

Common denial reasons include:

• Incorrect number of spinal regions billed.
• Lack of documented medical necessity.
• Missing treatment plan or progress notes.
• Maintenance therapy billed instead of active treatment.
• Missing or incorrect diagnosis codes.
• Failure to meet payer documentation requirements.

Because Medicare only covers active treatment, claims submitted for maintenance therapy are commonly denied.

3. Evaluation & Management (99202–99215)

Evaluation and Management (E/M) codes are appropriate when a separately identifiable evaluation is medically necessary. However, these common chiropractic CPT codes are frequently denied when billed together with Chiropractic Manipulative Treatment without sufficient documentation.

Common denial reasons include:

• Missing Modifier -25 when required.
• Documentation does not support a separately identifiable evaluation.
• Routine follow-up visits billed as E/M services.
• Duplicate billing.

Insurance payers closely review E/M services because they are commonly overused or incorrectly documented.

4. CPT 97140 – Manual Therapy

Manual therapy includes soft tissue mobilization, joint mobilization, and myofascial release. Although commonly performed, these chiropractic CPT codes often receive denials when billed alongside chiropractic manipulation because insurers may consider the services bundled.

Common denial reasons include:

• Missing Modifier -59 (when appropriate).
• Insufficient documentation showing the service was separate and distinct.
• Time requirements not documented.
• Services considered included within another billed procedure.

Proper documentation explaining why manual therapy was performed separately is essential for reimbursement.

5. CPT Code 97110 – Therapeutic Exercises

Therapeutic exercise is commonly performed alongside chiropractic adjustments. However, insurers frequently deny the 97110 chiropractic CPT code because documentation fails to establish:

• Medical necessity
• One-on-one patient supervision
• Time requirements
• Functional improvement goals

Detailed treatment notes help justify reimbursement while reducing payer challenges.

How to accurately bill for chiropractic adjustments and manipulations?

To accurately bill for chiropractic adjustments and manipulations, first select the correct chiropractic CPT codes and CMT code, then apply the appropriate modifier, adhere to compliance rules, and maintain proper documentation. Avoiding claim denials requires more than simply applying the correct code. Even minor documentation errors can result in claim denials or payment delays. 

To improve claim acceptance rates, chiropractors should follow these best practices:

• Select the correct CPT code based on the number of spinal regions treated. Such as code 98940 for spinal manipulation of 1 or 2 regions, code 98941 for Spinal manipulation of 3 to 4 regions and code 98942 for spinal manipulation of 5 regions.
• Support every claim with complete clinical documentation.
• Verify that the diagnosis justifies medical necessity.
• Use appropriate ICD-10 diagnosis codes.
• Apply modifiers (such as Modifier -25 or Modifier -59) only when documentation supports their use.
• Follow National Correct Coding Initiative (NCCI) edits and payer-specific billing guidelines.
• Document treatment plans, patient progress, and functional improvement.
• Verify insurance eligibility and chiropractic benefits before treatment.
• Perform regular coding audits to identify recurring billing errors.
• Keep coding staff updated with the latest CPT, ICD-10, and payer policy changes.

Practices that consistently review their coding processes and documentation can significantly reduce preventable claim denials and improve reimbursement accuracy. 

AmFac MM: Medical billing company in the USA Helps Reduce Chiropractic Claim Denials

Managing chiropractic billing in-house can be challenging because coding guidelines, payer policies, and documentation requirements continue to evolve. Even experienced staff may struggle to keep up with annual CPT updates, modifier changes, and insurance-specific billing rules.

AmFac MM supports chiropractic practices by managing both medical coding and billing throughout the revenue cycle. The team reviews clinical documentation, assigns accurate ICD, CPT, HCPCS, and modifier codes, verifies payer-specific billing requirements, and submits clean claims for reimbursement. When claim denials occur, billing specialists investigate the root cause, correct coding or documentation issues, and resubmit or appeal eligible claims. This integrated approach helps reduce coding-related denials, improve reimbursement accuracy, and maintain a more efficient revenue cycle for chiropractic practices.

Conclusion 

Using the correct CPT code for chiropractic is essential for reducing claim denials and maximizing reimbursements. Chiropractic CPT codes like 98940, 98941, 98942, 97140, and 97110 are among the most commonly used and also the most likely to cause denials when documentation, modifiers, or medical necessity requirements are not met. In such cases, outsourcing medical billing services to a medical billing company in the USA, like AmFac Medical Management, will help your practice improve coding accuracy, reduce denials, and keep your revenue cycle running smoothly.