When it comes to chiropractic billing, accuracy is everything. The 98943 CPT code is one of those niche yet crucial codes that often leaves providers and billing teams second-guessing. Whether you’re a chiropractor, a biller, or a practice owner, understanding this code and its requirements can help prevent costly denials and delayed reimbursements.
In this guide, built on real experience at Cures Medical Billing Services, we’ll break down everything you need to know from descriptions to modifiers, ICD-10 codes, and Medicare coverage. Our aim? To humanize the billing process and empower you with expert-backed, actionable insights.
The 98943 CPT code is defined as:
Chiropractic manipulative treatment (CMT): one or more regions other than the spine (e.g., extremities).
In simple terms, it’s used when a chiropractor treats areas like the shoulder, knee, wrist, or ankle, not the spine. It’s often billed in addition to spinal manipulation codes like 98940, 98941, or 98942, depending on how many spinal regions were treated.
At Cures Medical Billing Services, we’ve seen this code come into play in scenarios like:
The human element? Chiropractors often treat extremities as part of a holistic patient care plan. Yet many clinics miss out on reimbursement just because they’re unsure how to code or if the visit qualifies.
Many patients opt for cash payments, especially when services like extra spinal adjustments (98943) aren’t covered by Medicare. Others rely on their Medicare Advantage plans or secondary insurance to pick up what traditional Medicare doesn’t.
Here’s a simplified breakdown:
Service | Medicare Coverage | Medicare Advantage Coverage | |
Spinal Manipulation | Yes (98940, 98941, 98942) | Yes | |
Extra Spinal Manipulation | No | Varies by plan | |
Initial Exams (e.g., 99203, 99204) | No | Often included | |
Re-Exams (e.g., 99213, 99214) | No | Usually covered | |
Maintenance Care (S8990) | No | Sometimes covered | |
X-rays & Therapies | No | Plan-dependent | |
Some Medicare Advantage plans are far more generous than Original Medicare. They may cover new patient visits, follow-up re-evaluations, 98943 chiropractic codes for extremities, and even routine maintenance care. Don’t assume; verify coverage with each plan.
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Here’s the catch: Medicare typically does not reimburse CPT code 98943, as it only covers spinal CMT when medically necessary. That means even if you’re treating extremities, you may not get paid unless another insurer picks up the claim.
That said, non-Medicare payers, including commercial carriers and personal injury protection (PIP) plans, often reimburse for extremity manipulations when documentation supports medical necessity.
Tip from experience: Always verify payer policies in advance and include detailed SOAP notes to justify extremity treatment.
Yes, modifiers are sometimes required. When billed with spinal manipulation codes like 98941 or 98942, modifier 59 is typically added to 98943 to show it’s a distinct procedural service.
Example:
Without this modifier, insurers may reject 98943 as duplicate or bundled. At Cures Medical Billing, we train our staff to automatically assess when a 59 is needed to prevent denials proactively.
For successful reimbursement, ICD-10 codes must align with your procedure codes. Common diagnosis codes used with 98943 include:
Real-world tip: Ensure diagnosis codes directly correlate to the extremity being manipulated
To clarify: Yes, if billed alongside spinal codes. Without modifier 59, insurance systems may see it as a duplicate service. For solo billing of 98943, no modifier is needed in most cases, but always verify with payer policy.
For out-of-pocket or cash patients, the price for 98943 typically ranges:
At Cures Medical Billing, we advise providers to be transparent with pricing to help improve patient satisfaction and reduce billing disputes.
Navigating the world of chiropractic billing can feel overwhelming, but it doesn’t have to be. Understanding when and how to use the 98943 CPT code, documenting correctly, and applying the right modifiers are essential for clean claims and timely payments.
At Cures Medical Billing Services, we bring first-hand experience in handling chiropractic billing challenges. Whether you’re new to 98943 or battling claim denials, we’re here to help simplify the process and ensure your practice gets paid what it deserves.
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CPT code 98943 is used for chiropractic manipulation of extremities like the shoulders, elbows, wrists, knees, ankles, hands, or feet. It is not for spinal adjustments but for joint manipulation in areas outside the spine.
Yes, it can. If you’re also billing spinal codes (e.g., 98940, 98941, or 98942), be sure to add modifier 59 to 98943 to show it’s a separate, distinct service.
When billing alongside spinal codes, use modifier 59 on 98943 to indicate it’s a distinct procedural service. Without it, the claim might be denied or bundled.
Yes. You must pair 98943 with the appropriate ICD-10 code related to the treated extremity. For example:
Accurate coding improves claim approval.
It varies by payer, but:
No. CPT 98943 is a per-visit code, not based on time. It covers manipulation of one or more extremity regions in a single session.
You must document:
Yes, but it depends on the payer. Some insurers may deny 98943 if not billed with a spinal code, especially if documentation is insufficient. Always verify with your payer.
You can bill both if you treat the spine and extremities during the same session.
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