When it comes to chiropractic billing, getting the 98940 CPT code right can mean the difference between fast reimbursement and frustrating denials. At Cures, we’ve helped hundreds of clinics streamline their chiropractic billing and boost claim approvals, and we’ve learned a few things along the way.
If you’re a chiropractor or manage billing for one, this post is for you. We’ll break down what CPT 98940 means, how to code it correctly, and which modifiers to use. We’ll also discuss whether Medicare or FSA covers it and how to maximize reimbursement.
Let’s get right into it.
CPT code 98940 is used to bill for chiropractic adjustments when the treatment involves 1 to 2 areas of the spine. It’s one of the maximum frequently used codes in chiropractic clinics. It’s part of a family of CMT codes, which also includes:
Knowing exactly how many regions were treated is key to selecting the correct code.
According to CPT code guidelines, 98940 is defined as:
“Chiropractic manipulative treatment (CMT); spinal, 1-2 regions.’’
That includes evaluation, treatment, and the manipulation itself. No need to bill separately for those steps; they’re all bundled into this one code.
Reimbursement varies based on your payer, region, and participation status. Here’s what we typically see at CuresMB:
Payer Average Reimbursement
Medicar ~$28.00 to $32.00
Private Insurance $35.00 to $45.00
Tip from experience: Regularly update your fee schedule to match payer changes. It’s easy to drop revenue if you’re underbilling.
Yes, but there’s a catch.
Medicare covers 98940 only when it’s considered medically necessary, and only for active treatment, not maintenance care.
That means you need to:
Modifiers make or break your claims. For CPT code 98940, the most common modifiers include:
Pro tip: Never use 98940 with modifier GY unless you’re billing for non-covered services and want a denial for secondary insurance.
The 98940 CPT code is FSA-eligible. Patients can use their Flexible Spending Account or HSA to cover chiropractic visits billed under this code.
Give patients itemized receipts if they’re using FSA funds this not only helps them get reimbursed but also builds trust and encourages them to return.
Out-of-pocket costs vary, but here’s what we usually see:
Payment Type Estimated Cost
Cash Patients $40 to $60
With Insurance Copay or 10–30% coinsurance
FSA/HSA Use Full eligible amount
While 98940 is strictly for chiropractic manipulation, it’s often billed alongside physical therapy codes like:
Always check with payers to avoid bundling issues and use the 59 modifier where needed to separate services.
Code Regions Description
98940 1–2 Spinal manipulation
98941 3–4 Spinal manipulation
98942 5+ Spinal manipulation
98943 Extra spinal Arms, legs, etc.
Using the right code is critical; medical coding just one region off can result in a denied or underpaid claim.
At Cures Billing Services, we specialize in chiropractic billing and CPT code optimization. We’ve seen clinics lose thousands a year due to incorrect coding, missing modifiers, or poorly documented notes.
Here’s how we help:
If you’re ready to get paid faster with fewer denials, we’re here to help.
The 98940 CPT code may seem simple, but it requires precision to bill correctly. From knowing how many spinal regions were treated to using the right modifiers and staying Medicare-compliant, every detail matters. Let Cures Billing Services handle your billing, so you can give your full attention to caring for your patients.
Ready to Simplify Your Chiropractic Billing?
Call Cures today or visit our site to explore our Medical Coding Services, Chiropractic Billing Services, and Revenue Cycle Management solutions.
CPT 98940 is used to reverberation chiropractic spinal operation connecting one to two regions of the spine. It refers to hands-on therapeutic adjustments aimed at improving joint motion, reducing subluxation, and relieving musculoskeletal symptoms.
Only qualified chiropractors can bill CPT 98940. The service must be deemed medically necessary and supported by a valid ICD-10 diagnosis, such as vertebral subluxation (M99.01–M99.05), depending on the affected spinal region.
Here’s a quick comparison of spinal adjustment billing codes:
Billing accuracy is based on the number of distinct regions manipulated during the session.
Yes but only for dynamic treatment of a spinal subluxation. Medicare does not reimburse maintenance chiropractic care. Proper use of modifiers like AT (Active Treatment) or GA (ABN on file) is essential for coverage.
Proper documentation is crucial to avoid claim denials. Your clinical notes should include:
Out of these, the payer may reject the claim.
Use these modifiers when billing CPT 98940, depending on the payer and situation:
Billing frequency depends on the patient’s diagnosis, progress, and payer rules. While commercial plans may vary, Medicare generally limits spinal manipulation to once per day, with frequency tapering as improvement occurs.
Yes, but only if a separate evaluation and management (E/M) service was performed. In this case:
Documentation should clearly support both services.
Some commonly accepted ICD-10 codes include:
Note: Medicare requires subluxation to be the primary diagnosis.
Continuing up-to-date with reimbursement trends helps optimize your billing strategy.
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