Many providers have received a letter from Anthem indicating that the ratio and use of CMT codes 98941, 98942, and 98943 are above the average for the industry.

If you received such it is an indication that your ratio is too high.

Typically about 50-55% of patient visits are 98941 with the remainder being 98940 with a small amount of 98942.

98943 should only reflect patients with a direct diagnosis and complaint related to an extremity

If you are above this does not mean you are wrong but can cause an audit to see if you can justify use. Be mindful for 98941 there must be 3 spinal regions diagnosed and should correspond to direct complaints. While there can be some relation to a contiguous region it most often should reflect 3 areas minimum of complaint.

Look at your % and see where you fall. If you are above 55% of 98941 be sure you have patients not only with 3 different regional diagnoses but also match complaints not simply adjacent with.

This letter is a warning that they see something. Get the stats of your ratios and assure you can demonstrate proper use and would suggest to not go above the typical ratios with regularity or this will risk a specific audit.



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