CPT Codes 98940, 98941 and 98942: 2026 Rates, Modifiers and Denials

Chiropractic Manipulative Treatment is a hands-on therapy used by chiropractors to improve joint movement, correct spinal alignment, and reduce nerve interference. The treatment involves applying controlled force to specific joints, most often in the spine, to restore proper motion and function.

CMT plays an important role in patient care by helping reduce pain, improving mobility and supporting recovery from musculoskeletal conditions. It is commonly used to treat back pain, neck pain, headaches, and other joint-related issues, promoting overall physical well-being. To ensure correct billing and payment for these services, chiropractors must use the proper CPT codes, which reflect the exact number of spinal regions treated during a session.

This blog will provide a clear and detailed explanation of CPT codes 98940, 98941 and 98942 to help chiropractors achieve accurate billing and compliance.

Overview of CPT Codes for Accurate Chiropractic Billing

• CPT Code 98940: CMT of 1 – 2 spinal regions

CPT code 98940 is used when a chiropractor performs spinal manipulation on one or two spinal regions during a single session. It is typically selected for localized pain or injury, such as adjusting the cervical and lumbar areas for neck pain and lower back discomfort, or the cervical and thoracic regions for tension headaches and mid-back stiffness.

• CPT Code 98941: CMT of 3 – 4 spinal regions

CPT code 98941 applies when three or four spinal regions are adjusted in one visit. It is often used for cases involving more widespread spinal issues such as neck tension, mid-back discomfort and lower back pain requiring adjustments to the cervical, thoracic, and lumbar areas, or including the sacral region for posture-related concerns.

• CPT Code 98942: CMT of 5 spinal regions

CPT code 98942 is selected when all five spinal regions – cervical, thoracic, lumbar, sacral, and pelvic – are adjusted during the same session. This is generally used for complex cases such as post-accident recovery or conditions causing stiffness and pain throughout the spine.

How Much Do CPT 98940, 98941 and 98942 Pay in 2026?

CPT 98941 has an illustrative national non-facility base of $38.41 at the non-QP conversion factor. Locality and other adjustments affect payment. Select the code for the spinal regions actually treated and documented.

The CMS October 2026 files use conversion factors of $33.4009 for non-QPs and $33.5675 for eligible qualifying APM participants. Practice participation alone does not establish QP eligibility.

How the 98941 rate is built

CMS lists 98941 non-facility RVUs of 0.69 work, 0.45 practice expense and 0.01 malpractice, totaling 1.15. Multiplying by $33.4009 gives $38.41 before geographic and other adjustments.

How to check your contracted 98941 rate

Commercial payment for CPT 98941 varies by payer, plan, provider network, location, and contract. No reproducible primary-source national average is available for comparison. The Medicare non-facility base above is a separate reference and does not predict a commercial allowed amount. For a contract review, compare the payer’s current fee schedule with remittance advice for 98941 by plan and location.

The difference between a billed charge and an allowed amount should be interpreted using the applicable contract and remittance advice; it should not automatically be labeled lost revenue. Review a denied claim against the payer’s policy and the documentation for that date of service. The next section explains a Medicare modifier issue and should not be generalized to commercial plans.

Medicare Rules for Chiropractic Billing

Medicare has specific rules for paying chiropractors, especially for Chiropractic Manipulative Treatment billed under CPT codes 98940, 98941, and 98942.

• Medicare Covers CMT Only

Medicare only pays when the treatment is active care for spinal manipulation to correct a subluxation. Any other services that chiropractors may provide such as massage therapy, acupuncture, exercises, or therapeutic modalities are not covered under Medicare Part B, even if they are given during the same visit.

• Requirement for Subluxation Diagnosis

To be covered, the claim must include a spinal subluxation diagnosis. This can be shown through an X-ray taken within a reasonable period or by using specific examination findings that meet Medicare’s definition of subluxation.

• AT Modifier Requirement

When the treatment is active and corrective, chiropractors must add the AT modifier to the CPT code. Without this modifier, Medicare will treat the service as maintenance care and deny payment.

• Maintenance Care Not Covered

Medicare does not pay for treatment that is only to maintain a patient’s current condition or prevent symptoms from returning. Even if spinal manipulation is performed, this type of care is not reimbursable.

• Services Medicare Does Not Cover

Some services are excluded from coverage, even if provided during a covered CMT visit. A few of the examples include:

• Extraspinal manipulation covered by CPT 98943
• Ultrasound therapy
• Therapeutic exercises
• Electrical stimulation

Explain Medicare coverage and any patient cost before providing these services. Patient billing depends on the reason for non-coverage and applicable billing rules.

• Advance Beneficiary Notice (ABN)

For Original Medicare, distinguish an expected medical-necessity denial from a service excluded from the Medicare benefit. A valid ABN issued before care is needed to transfer liability for a normally covered service expected to be denied as not reasonable and necessary, such as maintenance spinal manipulation. For statutorily excluded services, an ABN is voluntary; it is not required solely because the service is non-covered. See CMS guidance on advance notices of non-coverage.

The AT Modifier: The Most Expensive Two Characters in Chiropractic Billing

Medicare will not pay 98940, 98941 or 98942 without the AT modifier when the service is active or corrective treatment. This has been mandatory on claims dated 1 October 2004 and later. A clean claim for a clinically appropriate adjustment, submitted without AT, is denied outright.

The rule is easy to state and easy to get wrong, because it is not simply “always append AT”. Medicare requires every chiropractic treatment to be categorised as acute subluxation, chronic subluxation, or maintenance therapy. AT belongs on the first two. It must never be appended to maintenance therapy, because maintenance care is not a covered Medicare benefit — and appending AT to it misrepresents the service.

What to append, and when

GA and GZ distinguish advance-notice status when a medical-necessity denial is expected. CMS guidance limits GA to specified reasonable-and-necessary denials when a signed ABN is on file. For qualifying claims, CMS assigns group code PR (Patient Responsibility) with GA and group code CO (Contractual Obligation) with GZ when no signed ABN is on file. A modifier alone does not establish that a notice is valid or that the beneficiary can be billed. Confirm the reason for noncoverage, ABN validity and timing, and claim-specific rules before billing. CMS chiropractic billing guidance and the Medicare Claims Processing Manual, Chapter 32, section 140.4.2 describe these conditions.

The four denials that account for most 98941 rejections

Three of those four are documentation problems wearing a billing costume. CO-4 is the only one a biller can fix alone. CO-11, CO-50 and CO-97 all trace back to what the clinician wrote in the note, which is why practices that separate documentation review from claim submission tend to see the same denials repeat month after month.

Can You Bill 98941 and 98943 Together?

Whether CPT 98941 and 98943 may be reported together depends on the payer, plan, coverage terms, code-pair edits, and date-of-service rules. CMS states that CPT 98943 is not a Medicare chiropractic benefit. For commercial plans, check the specific plan’s current coverage and coding policy before billing. Do not add modifier 59 by default. CMS’s 2026 Medicare NCCI guidance describes modifier 59 as a distinct procedural service; it may be used only when the applicable rules permit it, the documentation supports a distinct circumstance, and no more specific modifier applies. A diagnosis pointer alone does not establish that a service is distinct. See CMS billing and coding guidance for chiropractor services and the 2026 Medicare NCCI Policy Manual, Chapter 1, section E.

The five spinal regions Medicare recognises

Because 98940, 98941 and 98942 are selected purely on region count, the region definitions are the whole game:

• Cervical — C1 through C7, including the atlanto-occipital joint
• Thoracic — T1 through T12, including the costovertebral and costotransverse joints
• Lumbar — L1 through L5
• Sacral — the sacrum and coccyx
• Pelvic — the ilium and the sacroiliac joint structures

Treating three of those five in one encounter is 98941. Treating two is 98940. The note must name each region and carry a supporting subluxation diagnosis for each — a treatment plan that says “adjusted the spine” supports 98940 at best, whatever was actually performed.

Documentation Requirements for Compliance

To get paid for CPT codes under Medicare, records must be complete and clearly prove the treatment was medically necessary. The notes should connect the patient’s condition, the diagnosis, and the number of spinal regions treated.

1. Key Elements to Document

• Pre-Manipulation Assessment

Before any CMT is performed, the chiropractor must conduct and document an initial assessment. This includes reviewing the patient’s history, symptoms and previous treatments to determine whether CMT is appropriate.

• Objective Findings

The records must include objective evidence of spinal subluxation and related conditions. This can be documented through physical examination findings, orthopedic or neurological tests, and when necessary, imaging reports.

• Diagnosis

The primary diagnosis must be a spinal subluxation, as required by Medicare, along with any supporting secondary diagnoses. The chosen CPT code (98940, 98941, or 98942) must match the number of spinal regions identified in the diagnosis.

• Treatment Plan

The treatment plan should clearly outline the frequency and duration of CMT sessions, the specific spinal regions being treated, and the therapeutic goals. The plan must align with the patient’s diagnosis and expected recovery progress.

• Patient Progress and Response

Each visit should include updates on the patient’s progress, such as reduced pain, improved mobility, or ongoing symptoms. If no improvement is noted, documentation should state the reason and any planned changes in treatment.

2. SOAP Notes Best Practices

Follow the SOAP format for each treatment visit:

S – Subjective: Patient’s description of pain, discomfort, or functional problems.

O – Objective: Physical exam findings, test results, or other measurable data.

A – Assessment: Professional judgment of the patient’s condition and need for continued care.

P – Plan: The treatment provided that day and the plan for future visits.

Common Billing Mistakes and How to Avoid Them

Even experienced chiropractors can face claim denials or payment delays if documentation and coding requirements are not strictly followed. Below are the most common mistakes in chiropractic billing with practical ways to prevent them-

• Incomplete Subluxation Documentation

Medicare coverage depends on a documented primary diagnosis of spinal subluxation supported by imaging or detailed physical exam findings. Denials occur when objective findings are missing or when the connection between diagnosis and treatment is unclear. Thoroughly recording pre-treatment findings, relevant orthopedic or neurological test results, and linking them directly to the number of treated spinal regions ensures claims meet the necessary standard.

• Confusing Required and Voluntary ABNs

Check why Medicare is expected to deny the service before selecting an ABN or claim modifier. A signature alone does not establish patient liability: the notice must be valid and timely. Statutorily excluded services follow different notice and modifier rules from medical-necessity denials.

• Poorly Maintained Treatment Notes

Vague or incomplete visit notes – especially those not following SOAP (Subjective, Objective, Assessment, Plan) format – make it challenging to justify medical necessity. It is crucial to use SOAP notes with specific symptom updates, measurable exam findings, and clearly defined treatment plans aligned to patient progress consistently. This ensures that documentation supports both compliance and reimbursement.

Outsourcing Chiropractic Billing & Coding Services as a One-Stop Solution

Offshore chiropractic billing and coding companies provide an all-in-one solution that streamlines your chiropractic billing process. These specialized teams ensure accurate coding, proper modifier usage and thorough documentation compliance. In fact, chiropractic practices can minimize claim denials and accelerate reimbursements by leveraging their expertise.

InfoHub Consultancy Services stands out as a trusted outsourcing Medical billing & coding service provider in India for providers seeking reliable offshore billing solutions. With a deep understanding of industry-specific regulations and a commitment to precision, our team ensures every claim is handled with care and expertise. Our dedicated team not only improves revenue cycle efficiency but also provides personalized support tailored to the unique needs of each practice.

FAQs

Q: Can CPT codes 98940 – 98942 be billed for pediatric patients?

Ans: But documentation must support medical necessity regardless of patient age.

Q: Are these CPT codes used for initial or follow-up chiropractic visits?

Ans: They apply to both, as long as manipulative treatment is performed.

Q: Can multiple CPT codes from 98940 – 98942 be billed in the same session?

Ans: Only one code reflecting the total regions treated should be billed per visit.

Q: Are there specific time requirements associated with these CPT codes?

Ans: Billing is based on regions treated, not time spent.

Q: What does CPT code 98941 mean?

Ans: CPT 98941 is chiropractic manipulative treatment of three to four spinal regions in a single encounter. It is the most frequently billed of the spinal CMT codes and pays $38.41 under the 2026 Medicare national fee schedule.

Q: Does CPT code 98941 require a modifier?

Ans: For Medicare, AT is required when 98941 is billed for active or corrective treatment; it must not be appended to maintenance therapy. When maintenance treatment is expected to be denied as not reasonable and necessary, GA is used only when a valid signed ABN is on file; GZ applies when no signed ABN is on file. For qualifying claims, CMS assigns PR liability with GA and CO provider liability with GZ. Verify the reason for noncoverage, ABN validity and timing, and claim-specific rules before billing a beneficiary.

Q: Can you bill 98941 and 98943 together?

Ans: CMS excludes CPT 98943 from the Medicare chiropractic benefit. Coverage and code-pair rules for commercial plans vary, so check the specific payer’s current policy before billing 98941 with 98943. Do not add modifier 59 automatically; use a distinct-service modifier only when the payer’s rules permit it, the documentation supports the distinct service or site, and no more specific modifier applies. See the 2026 Medicare NCCI Policy Manual, Chapter 1 for CMS’s Medicare modifier guidance.

Q: What is the CPT code for CMT of 3 to 4 regions?

Ans: CPT 98941. One or two regions is 98940, five regions is 98942, and extraspinal manipulation is 98943. The code is selected on the number of spinal regions treated and documented, not on the time spent or the technique used.

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