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Chiropractic Coding & Compliance Alert

Reader Question:

CMT Codes Do Not Need Modifier 51

Question: A patient with a complaint of back pain presented to the doctor. After identifying subluxation, the doctor performed Chiropractic Manipulative Therapy (CMT) for three vertebrae in two regions. Do I apply modifier 51 in this scenario?

Minnesota Subscriber

Answer: There is no need to use modifier 51 (Multiple procedures) in this scenario. The beauty of CMT codes is that they already have a multiplier built into their descriptors. Code 98940 (Chiropractic manipulative treatment [CMT]; spinal, 1-2 regions) is for one to two regions and then the number of regions increases from there with the other code choices. You should only use one code as the descriptors illustrate: 98941 (… 3-4 regions), 98942 (… 5 regions), or 98943 (… extraspinal, 1 or more regions).You shouldn’t use a modifier 51 with CMT.

Important: CMT codes are based on the regions treated, not the number of vertebrae. So if your provider treats three vertebrae in two regions, 98940 is the correct code and you don’t need a modifier.

Tip: Make sure that your diagnosis supports the levels of subluxation. If you report three to four regions (98941), then you must have at least three subluxation diagnosis codes.

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