Current Procedural Terminology (CPT) codes are standardized alphanumeric identifiers used in the United States healthcare system to describe medical services for billing and reimbursement. Maintained by the American Medical Association (AMA), these codes form the foundation of medical billing. CPT code 98941 is a specific identifier used by doctors of chiropractic to report a particular level of care provided during a single treatment session. Accurate application of this code ensures the service is properly communicated and considered for coverage by the patient’s insurer.
Defining Chiropractic Manipulative Treatment
The service described by CPT code 98941 is Chiropractic Manipulative Treatment (CMT), the primary therapeutic procedure used in chiropractic care. CMT involves the application of a controlled force to a restricted or dysfunctional joint, most often a spinal joint. The goal of this manual adjustment is to restore normal joint mobility, reduce pain, and improve musculoskeletal structure. This technique is typically performed as a high-velocity, low-amplitude thrust, designed to move the joint within its anatomical limits.
The manipulation targets areas of the spine exhibiting segmental dysfunction, where motion is restricted or alignment is compromised. Correcting these restrictions alleviates nerve irritation and soft tissue tension that contribute to the patient’s symptoms. Although the technique often results in an audible “pop,” the therapeutic effect comes from the mechanical and neurological changes induced in the joint and surrounding tissues.
The Significance of 3 to 4 Spinal Regions
CPT codes for Chiropractic Manipulative Treatment are differentiated based on the number of distinct anatomical spinal regions treated. The spine is divided into five standardized regions for coding purposes: Cervical (neck), Thoracic (mid-back), Lumbar (low back), Sacral (base of the spine), and Pelvic (sacro-iliac joint). CPT code 98941 is reserved for a treatment session where the chiropractor manipulates three or four of these five spinal regions.
This level of treatment indicates a multi-regional condition requiring focused intervention across a broader expanse of the spine. For example, treating the Cervical, Lumbar, and Thoracic regions meets the criteria for a three-region treatment. The need to treat multiple, distinct areas makes 98941 a more comprehensive service than codes used for fewer or more regions.
Application of the Code in Billing
CPT code 98941 communicates to insurance companies that a complex, multi-regional treatment was performed. Since this code represents a higher volume of work, it generally corresponds to a higher reimbursement rate. This code is billed once per visit, regardless of the exact number of manipulations performed within the three or four treated regions.
A primary requirement for using 98941 is the demonstration of “medical necessity” for each of the three or four regions treated. The patient’s medical record must contain objective evidence, such as physical examination findings, to justify why manipulation was required in every region claimed. Documentation must show an active, measurable functional impairment or joint dysfunction in each specific area, like reduced range of motion. Without clear documentation supporting the treatment of three or four separate regions, the insurance company may deny the claim or reduce the payment.