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Understanding the 98942 CPT Code - A Chiropractor’s Guide to Accurate Billing

A professional person seen on clipboard against the white board learn about the 98942 CPT code for medical billing process.

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.

What Is the 98942 CPT Code?

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.

  • 98942 CPT code description: Chiropractic manipulative treatment (CMT); spinal, 5 regions.

It applies when a chiropractor treats the cervical, thoracic, lumbar, sacral, and pelvic areas during one session.

What Does CPT Code 98942 Mean in Practice?

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.

98942 CPT Code vs. Other Chiropractic CPT Codes

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.

Real Experience - Common Billing Errors with 98942

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.

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98942 CPT Code Reimbursements

Including related codes in your documentation ensures smoother claims:

  • 98940 CPT code: For adjustments in 1-2 spinal regions
  • 98941 CPT code: For 3-4 spinal regions
  • 98943 CPT code: For extra spinal regions like shoulders, knees, or wrists

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.

ICD-10 Codes for Chiropractic Billing

Accurate ICD-10 coding supports the medical necessity for 98942. Common examples include:

  • M54.5 – Low back pain
  • M99.01-M99.05 – Segmental and somatic dysfunction across spinal regions
  • M54.2 – Cervicalgia

Ensure your chiropractic diagnosis codes align with the spinal regions you treat and document.

Why Proper Use of 98942 CPT Code Matters

Incorrect use of 98942 CPT can result in:

  • Claim denials
  • Delayed payments
  • Compliance risks

Cures Medical Billing helps chiropractors like you stay compliant while increasing cash flow.

Final Thoughts

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.

Frequently Asked Questions (FAQs)

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:

  • Clear charting of subluxations or dysfunction in all 5 spinal regions
  • Objective findings
  • Patient complaints tied to those regions
  • ICD-10 codes that support medical necessity

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:

  • M54.5 (Low back pain)
  • M54.2 (Cervicalgia)
  • M99.05 (Segmental dysfunction of the pelvic region)
  • M99.01-M99.04 for other spinal regions

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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