98943 Chiropractic Extraspinal Adjustment

I’ve heard different policies and coding requirements for the 98943 and a lot of inconsistent feedback from payers. How do I code my 98943 Chiropractic extraspinal adjustments for proper 3rd party payer reimbursement?

There has been a recent stir in the Chiropractic billing world recently regarding extraspinal billing! For several years, payers have been requiring a 51 modifier (or a 59 modifier for others) be used on the 98943 Chiropractic extraspinal adjustment when the service is performed in conjunction with a Chiropractic spinal adjustment (98940-98942).

The use of the 51 modifier for most payers will actually decrease the allowed reimbursement for the 98943, but the payers would not accept a spinal/extraspinal billing combination without it. The good news is that payers, including Optum Health payers, are starting to accept the 98943 service without the 51 modifier, even when billed in conjunction with a 98940, 98941, or 98942.

Our recommendation for coding the 98943 for optimal reimbursement is to first look at the diagnosis pointers associated with the service. Look to make sure that only extremity-related codes are being utilized for the 98943 and that no spinal-related codes are used. Also make sure that the diagnoses used are properly describing both the area being adjusted and the condition being treated.

Check with your Chiropractic billing service company or Chiropractic billing service software for updates on payers that are accepting the service without the 51 modifier and inquire about local payers you are billing for their modifier policy on the 98943 service.

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Todd Crabtree

Todd Crabtree

Founder & Chief Technology Officer. Founded Clinic Doctor Inc. in 2004, to innovate the providing of insurance billing services to healthcare providers in chiropractic clinics that lacked the resources to pay for qualified billing professionals.

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2 thoughts on “98943 Chiropractic Extraspinal Adjustment”

  1. What are the best diagnosis codes to submit when using 98943?

    What are the documentation requirements?

    Thank you

  2. I have a patient that is a veteran and is covered by the Veteran’s Choice Program. This program pays according to the Medicare fee schedule. Although Medicare does not cover for the extraspinal modality under chiropractic care (CPT code 98943) I was told by an associate at the VA Hospital where the claims are processed that the program does pay for that service but that code is not accepted under Medicare guidelines. She stated that there is another code that is accepted and will actually speed up the claims process because the system will automatically process the claim as opposed to a claims specialist having to manually price for the service but she refused to give me the code. She stated that she can’t tell me what it is. I have looked everywhere and that is the only code that I can find for that modality. Is there another code or possibly a modifier that needs to be included to speed up the process?

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