Consultation Codes in Chiropractic: What They Really Mean

When a “Consultation” Isn’t a Consultation in Chiropractic Care

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In chiropractic practices, the term “consultation” is used in many ways. But when it comes to billing and coding, consultation codes in chiropractic have a very specific meaning—one that often gets misunderstood.

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Let’s break down what consultation codes in chiropractic actually mean, when you should use them, and why you should proceed with caution.

Not All Consultations Are Code-Worthy

Chiropractors commonly use the word “consultation” to describe two things:

• The initial visit when gathering a patient’s history
• A free pre-care interview, sometimes called a “meet-and-greet”

However, neither of these scenarios qualifies for consultation codes in chiropractic. The codes in question—99242–99245 (outpatient) and 99252–99255 (inpatient)—are official Evaluation and Management (E/M) codes reserved for referral-based services.

What Counts as a True Consultation?

To use these consultation codes, you must meet three conditions:

1. A referral from another provider (this must be documented)
2. A formal evaluation and opinion provided by you
3. A written report sent back to the referring provider

If any of these steps are missing, the service does not qualify as a consultation under CPT rules.

👉 Example: If a medical doctor refers a patient to you for a second opinion and you send them a report after your evaluation, this could justify using a consultation code.

But if the patient walks into your office without a referral, it doesn’t count—no matter what you call it.

Use E/M Codes Instead

When you’re conducting a typical patient history or a free consultation, skip the consultation codes and use standard E/M codes (9920X for new patients or 9921X for established ones). These better reflect the actual service you’re providing and avoid compliance risks.

Why This Matters for Chiropractic Billing

Using the wrong code may lead to denied claims, compliance audits, or payment issues. Since consultation codes in chiropractic care are rarely needed, most offices will never use them—and that’s okay.

If you ever do find yourself with a legitimate referral situation, remember: consultation codes are used in place of your regular E/M codes, not in addition to them.

Final Thoughts

Consultation codes in chiropractic are precise and narrowly defined. Unless you’ve received a referral from another provider and follow all required steps—including sending a report back—don’t use them.

Stick with your E/M codes for history-taking and free consultations, and stay compliant with best practices.

Need help figuring out what code applies to your scenario? Schedule a FREE Discovery Assessment today to find out if we can help you keep your practice protected.