Chiropractic Coding: CPT Codes 98940-98942

Understanding Medicare guidelines and chiropractic coding requirements is essential for chiropractors to ensure accurate billing and reimbursement. Proper use of CPT codes 98940–98942 helps practices document chiropractic manipulative treatment (CMT) services correctly while remaining compliant with Medicare coverage policies. Below is an overview of the coverage requirements and the commonly used chiropractic CPT codes.

Overview of Coverage Requirements

The coverage of chiropractic services is precisely limited to treatment by means of manual manipulation (i.e., by use of the hands) of the spine to correct a subluxation.

Subluxation is defined as a motion segment in which alignment, movement integrity, and/or physiological function of the spine are altered, although contact between joint surfaces remains intact. Let’s find more information on Medicare’s billing and Chiropractic Coding: CPT Codes 98940-98942.

Manual devices – the devices that can be controlled manually (e.g. those which are hand-held with the drive of the force of the device) might be used by chiropractors to perform manual manipulation of the spine. No extra payment is available for use of the device, nor does Medicare recognize an additional charge for the device itself.

Another diagnostic or therapeutic service not furnished by a chiropractor or under the chiropractor’s order is covered.

• CPT Code 98940: Chiropractic manipulative treatment (CMT); Spinal, 1-2 regions
• CPT Code 98941: Chiropractic manipulative treatment (CMT); Spinal, 3-4 regions
• CPT Code 98942: Chiropractic manipulative treatment (CMT); Spinal, 5 regions

Documentation Requirements

Improve insurance reimbursements

• Verify and know your patient’s insurance coverage. Two patients can have different insurance contracts with coverage from the same company. Contrariwise, one insurance carrier might reimburse for a specific CPT while the second one will deny it.
  Verifying eligibility prior to each and every new patient appointment is therefore the essential first step in the claim revenue cycle. Also, you need to verify existing patient eligibility after a certain period.
• You have to complete pre-authorizations before starting treatment (if applicable). If the patient has the chiropractic benefits on their plan, your claims may be denied if there are pre-authorization requirements in place.
• Analyze denied claims. This can be the biggest issue that negatively affects revenue is Denied claims. In fact, according to the Government Accountability Office, up to 25% of insurance claims are denied. Once you analyze your denials, you can recognize patterns that can be corrected.
• Understand Medicare’s billing and documentation. Documentation has one of the highest error rates when Chiropractors bill to Medicare. This rate includes rejected and denied claims. Medicare only covers CPT codes 98941, 98942, 98943 for Chiropractic practice.
  All other CPT codes billed to Medicare will be either deny or reject. Also, while submitting a claim to Medicare for manipulation, you must add the Acute Treatment (AT) modifier if you want to get paid.
• Properly document your patient encounters. To minimize the probabilities of triggering an audit and possibly paying penalty charges and fines, make sure to document your encounters properly. Your SOAP notes should specify the need for treatment, and contain treatment goals, objective measures for patient progress, the patient’s development, and the treatment plan.
  The latter should include duration and frequency. Whenever you are going to bill Medicare, make sure all documentation is complete and according to established guidelines. 

2025–2026: Medicare AT Modifier, Spinal Region Counting, and Documentation Standards

Three critical compliance requirements govern chiropractic CMT billing under Medicare and major commercial payers in 2025–2026, and each one is a direct denial trigger when handled incorrectly.

The first is the Medicare AT modifier, which is mandatory on every CMT claim submitted to Medicare for codes 98940, 98941, and 98942. The AT modifier signals active treatment rather than maintenance care, and omitting it results in automatic non-payable denial with no appeal pathway — Medicare explicitly does not cover maintenance chiropractic, so a claim without AT is read as maintenance by default regardless of what the SOAP note says.

The second is spinal region counting, which is the single most audited element in chiropractic CMT coding. CMS recognizes five spinal regions: cervical, thoracic, lumbar, sacral, and pelvic. Correctly mapping each adjusted region to one of these five designations determines whether 98940 (1–2 regions), 98941 (3–4 regions), or 98942 (5 regions) is the appropriate code, and the operative note must name the specific regions treated, not just the number.

Billing 98942 when documentation only supports two adjusted regions is an upcoding violation that triggers payer recoupment and OIG audit exposure; equally, consistently billing 98940 when three or more regions are documented is a pattern that MACs flag as under-coding, disrupting the expected billing distribution for chiropractic practices.

The third is SOAP note specificity. CMS Article A56273 requires that documentation include a pre-manipulation assessment, objective findings establishing subluxation, the number of spinal regions treated, and measurable progress toward functional goals.

Generic notes stating “patient reports improvement” without quantified functional outcomes no longer satisfy Medicare documentation standards and are the primary reason chiropractic practices face post-payment recoupment.

MBC’s chiropractic billing specialists audit AT modifier placement, validate region counts against operative documentation, and review SOAP note compliance before every submission, protecting your practice from the documentation-driven denials that account for the majority of chiropractic revenue loss.

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FAQs: Chiropractic Coding

Alex Peter

A Medical Coding Subject Matter Expert with over 16 years of experience in ICD-10 and CPT coding, clinical documentation, and revenue cycle management. Shares actionable insights to improve billing accuracy and support compliance-driven healthcare practices.