When it comes to chiropractic billing, one of the most frequently used and often misunderstood procedure codes is the 98942 CPT code. At Cures Medical Billing Services, we’ve seen firsthand how improper use of this code can lead to claim denials, delayed payments, or underbilling.
This guide will explain what CPT code 98942 means, when to use it, how it compares with other chiropractic CPT codes, and what you can do to maximize reimbursement, all from a humanized, real-world billing perspective.
The 98942 CPT code is used for chiropractic manipulative treatment (CMT) involving five spinal regions. This is the most comprehensive spinal CMT code, representing the highest complexity in manual spinal adjustments.
It applies when a chiropractor treats the cervical, thoracic, lumbar, sacral, and pelvic areas during one session.
From our experience at Cures Medical Billing, chiropractors often undercode their services. For instance, they might bill 98941 (which covers 3-4 regions) even when they treat all five.
That means lost revenue.
Understanding what CPT code 98942 means enables chiropractors to bill accurately and receive payment for the care they provide. It’s not just about revenue, it’s about valuing your time and skill.
CPT Code | Description | Number of Regions |
98940 | Spinal CMT | 1-2 regions |
98941 | Spinal CMT | 3-4 regions |
98942 | Spinal CMT | 5 regions |
98943 | Extra spinal CMT | 1 or more extra spinal regions (e.g., extremities) |
Tip: Always document the specific regions treated during the visit. Payers may request records.
We’ve worked with dozens of chiropractic clinics, and here’s a pattern we often see:
“I billed 98941, but my notes show treatment in all five regions,” says Dr. R, a long-time client.
After a quick audit, we found they could have billed 98942 for 60% of their visits, which means higher reimbursements with the same work.
That’s the kind of insight Cures Medical Billing brings to every client.
Including related codes in your documentation ensures smoother claims:
Also, watch out for L1960 CPT Code (used for orthotic devices) or 19103 CPT code (breast biopsy), which sometimes show up on audits due to miscoding.
Accurate ICD-10 coding supports the medical necessity for 98942. Common examples include:
Ensure your chiropractic diagnosis codes align with the spinal regions you treat and document.
Incorrect use of 98942 CPT can result in:
Cures Medical Billing helps chiropractors like you stay compliant while increasing cash flow.
Using the 98942 CPT code correctly ensures you’re being paid for your work, not shortchanging your practice. From accurate chiropractic CPT codes to ICD-10 alignment and payer policy management, Cures Medical Billing Services is here to help you streamline your revenue cycle.
Let’s make billing simple, compliant, and profitable.
Contact us today for a free audit and discover how many of your 98941 claims could’ve been 98942.
The 98942 CPT code is used to bill for chiropractic manipulative treatment (CMT) involving five spinal regions. It’s the most comprehensive spinal adjustment code available and should only be used when all five spinal regions (cervical, thoracic, lumbar, sacral, and pelvic) are treated during the same visit.
In practical terms, 98942 represents high-complexity spinal manipulation. If you’re adjusting all five regions in one session, this is the correct code to bill. It acknowledges the increased clinical effort and time compared to treating fewer regions.
Reimbursement for the 98942 CPT code varies by payer. Some private insurance companies reimburse between $40 to $75 per session, depending on your provider contract and location. Medicare may not reimburse unless very specific medical necessity documentation is met.
Medicare typically covers only spinal CMT for subluxation, and coverage of 98942 is limited. You’ll need strong documentation and a verified diagnosis code to support medical necessity for all five regions. Often, 98941 is more commonly approved under Medicare.
You should include:
Without this, insurers may down code your claim or deny it.
Yes, 98943 are for extra spinal manipulations, like extremity adjustments (e.g., shoulder, wrist, and knee). You can bill 98942 and 98943 together if both services are provided and properly documented.
Common ICD-10 codes for chiropractic that support 98942 include:
Make sure each diagnosis code matches the treated region.
No if fewer than five regions are treated, use 98940 (1-2 regions) or 98941 (3-4 regions) instead. Billing 98942 without documentation for all five regions could lead to audits or denials.
From our experience at Cures Medical Billing, many providers under code due to documentation habits or fear of audits. But if you’re truly treating five regions and documenting properly, you’re entitled to use 98942 and it increases revenue per visit.
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