In addition, there must be the expectation of improvement. You must provide the documentation of positive outcomes (progress). And, you must know the insurance company's reimbursement guidelines.

Here's a typical insurance reimbursment guideline: "Chiropractic services are medically necessary when the member (patient) has a neuromusculoskeletal disorder, the medical necessity for treatment is clearly documented, and improvement in the condition is documented within the first two weeks of chiropractic care. When no improvement is documented within the first two weeks, additional chiropractic care is considered not medically necessary unless the chiropractic care has been modified. If the chiropractic treatment has been modified, improvement in the condition should be documented within 30 days."

So, if you document medical necessity with significant objective deficits, and you document improvement in the condition within two weeks, you will get paid for all medically services until your patient reaches maximum medical improvement (MMI) or pre-injury status.

And, if no improvement in the condition is documented within the first two weeks, you must modify the chiropractic treatment as needed and report the improvement within 30 days.

Proper documentation of medical necessity and positive outcomes will provide you with access to all of the treatment necessary to return your patient to MMI or pre-injury status. And, the insurance companies will pay you for those services.

Yes, it requires a little change in your diagnostic and documentation procedures, but the reward is well worth it… eliminating those costly denied claims.

About Critical CMT Codes

The CMT codes are the most complicated, least understood, and the most difficult to document. And, they pose the greatest threat for a post-payment review audit.

CMT codes (98940-98943) include extensive documentation requirements that are time consuming and are very difficult to document without diagnostic testing.

The following information was taken from the ACA 2nd Edition Clinical Documentation Manual describing the nine components associated with documenting the CMT codes.

Three pre-service components include: documentation and chart review; imaging review; test interpretation and care planning.

Three intra-service components include: pre-manipulation and palpation procedures; manipulation procedures; post-manipulation assessment procedures.

Three post-service components include: chart documentation; consultation; reporting.

The times shown represent the time requirements for the appropriate level of Evaluation and Management service included in each level of CMT.

CMT required times:

98940 – 12 minutes total time. Plus the 9 components.
98941 – 17 minutes total time. Plus the 9 components.
98942 – 21 minutes total time. Plus the 9 components.
98943 – 14 minutes total time. Plus the 9 components.

CMT codes can be used as audit traps. If you use the CMT codes, and you are subject to an insurance post-payment review audit, you must have the required documentation… all of it, including the time (number of minutes).

"With education I can do by choice what other men do by the constraints of fear."
Aristotle - 320 BC

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William C. Wetmore, DC is a Pittsburgh, PA – based Provider Compliance Consultant. He can be reached at or by calling 412-377-2426.