CPT Code 98940: Chiropractic manipulative treatment billing guide

Key Takeaways

CPT code 98940 covers chiropractic manipulative treatment (CMT) of 1-2 spinal regions per visit

Medicare requires the AT modifier on every 98940 claim; omitting it causes automatic denial

Documentation must name each spinal region treated and link manipulation to a documented subluxation or segmental dysfunction

Pabau’s claims management software helps chiropractic practices track modifier requirements and reduce claim errors before submission

CPT code 98940 covers chiropractic manipulative treatment (CMT) of one or two spinal regions performed during a single patient visit. It is one of the most commonly billed chiropractic codes in the US, and Medicare reimburses it only when the claim carries the AT modifier and the documentation links the manipulation to a subluxation.

This guide covers the code definition, spinal region rules, AT modifier requirements, companion ICD-10 codes, and how to keep claims from being denied at chiropractic software-supported practices.

The American Medical Association (AMA) maintains the CPT code set, and 98940 sits within the Chiropractic Manipulative Treatment (CMT) family alongside 98941, 98942, and 98943. Code selection within this family is determined by a single variable: the number of spinal regions manipulated during a visit.

CPT code 98940 definition and clinical description

CPT code 98940 is defined as: Chiropractic manipulative treatment (CMT); spinal, 1-2 regions. It applies when a chiropractor performs hands-on spinal manipulation targeting one or two of the five recognized spinal regions during a single patient encounter.

The five spinal regions recognized for CMT billing are:

• Cervical (neck)
• Thoracic (mid-back)
• Lumbar (lower back)
• Sacral (base of spine)
• Pelvic (including the sacroiliac joint complex)

A patient presenting with isolated neck pain where only the cervical spine is manipulated qualifies for 98940. So does a patient with combined cervical and lumbar complaints where both regions receive manipulation. The moment treatment extends to a third region, the correct code becomes CPT code 98941 (3-4 spinal regions).

Common clinical presentations billed under 98940 include neck pain, lumbar discomfort, thoracic tension, and limited spinal mobility confined to one or two regions. The code does not cover extraspinal manipulation of the extremities or ribs; CPT 98943 handles those sites and is not covered by Medicare.

Spinal region count and the 98940 vs 98941 vs 98942 decision

The entire CMT code family is built on region count. There is no clinical judgment involved in code selection beyond an accurate count of which spinal regions received manipulation during the visit.

Upcoding from 98940 to 98941 without clinical documentation supporting three or more treated regions is a compliance risk. Payers audit region counts against SOAP notes; when the note references only one or two regions, a 98941 claim triggers a denial or an overpayment request.

Medicare AT modifier requirements

Medicare Part B covers chiropractic spinal manipulation only when it corrects a documented subluxation. The coverage is narrow on purpose: Medicare pays for active or corrective treatment, not maintenance care.

According to CMS Article A56273, any claim for CPT codes 98940, 98941, or 98942 submitted without the AT modifier will be automatically considered not medically necessary and denied. The rule is absolute: no AT modifier, no payment.

Key AT modifier rules for 98940:

• Append AT to every 98940 claim line when the service represents active or corrective treatment
• Do not append AT when the visit is maintenance care (Medicare does not cover maintenance CMT)
• Only providers enrolled with Medicare under specialty code 35 (Chiropractor) may bill CMT codes; all other specialties face automatic denial
• The AT modifier signals to the payer that the manipulation addresses acute or chronic subluxation requiring active intervention, not routine wellness maintenance

Private payers (Aetna, Blue Cross Blue Shield, UnitedHealth) have their own modifier policies that may differ from Medicare. Verify each payer’s contract before assuming AT carries over universally. Using claims management software that flags modifier requirements by payer helps prevent these submission errors at scale.

ICD-10 codes that support medical necessity

Medical necessity for 98940 depends on a supporting diagnosis that documents subluxation or segmental dysfunction. The ICD-10 code must reflect the specific spinal region treated; a mismatch between the diagnosis region and the manipulated region is a common audit trigger.

For Medicare claims, the M99.0x subluxation complex codes carry the strongest medical necessity support because they explicitly reference subluxation, which is the statutory basis for Medicare chiropractic coverage. Symptom codes like M54.2 and M54.50 may be used as secondary or supporting diagnoses but should not stand alone as the primary code on a Medicare 98940 claim if subluxation codes are available and clinically appropriate.

Maintaining structured patient records that link each ICD-10 code to specific examination findings reduces the documentation burden during audits and supports consistent, accurate billing across a practice’s full caseload.

Documentation requirements for billing CMT

Billing 98940 without airtight documentation is the single largest contributor to chiropractic claim denials and post-payment audits. The Centers for Medicare and Medicaid Services (CMS) sets the documentation floor through its national coverage policy for chiropractic services (NCD 240.1.3) and Billing and Coding Article A56273; most private payers use comparable standards.

A compliant 98940 note must include:

• Chief complaint: Patient’s primary presenting symptom tied to a spinal region
• Subluxation evidence: Objective findings (pain, tenderness, range-of-motion restriction, muscle spasm) supporting the presence of subluxation or segmental dysfunction
• Spinal region(s) treated: Explicit naming of each manipulated region (e.g., “cervical manipulation performed” not just “spinal adjustment”)
• Treatment response: Patient’s response to manipulation during the current visit
• Active treatment status: Clinical rationale confirming the visit is corrective, not maintenance, to support the AT modifier

A chiropractic intake form template that captures chief complaint, regional symptoms, and functional limitations at intake gives billing staff the raw material they need to substantiate medical necessity without hunting through freehand notes. Pairing intake data with structured SOAP note templates via digital intake forms connects what happened clinically with what gets submitted to the payer.

HIPAA-compliant record keeping also requires that documentation be maintained for a minimum of six years (or longer under state law), be available for payer audit within 30 days of request, and accurately reflect the service billed. Learn more about HIPAA-compliant record keeping for medical offices to ensure your documentation practices meet federal standards.

Reimbursement rates and RVUs

Medicare reimbursement for 98940 is calculated using the Medicare Physician Fee Schedule (MPFS) and varies by geographic location. Rates are updated annually each January 1; always reference the current-year fee schedule rather than prior-year figures, which may no longer be valid.

The CMS Physician Fee Schedule lookup tool lets you search 98940 by HCPCS/CPT code and view current payment amounts by locality, along with the Work, Practice Expense, and Malpractice RVU values that help practices benchmark expected reimbursement before submitting claims.

Private payer rates for 98940 are negotiated through individual contracts and typically exceed Medicare rates. When a practice lacks a contracted rate with a commercial payer, the claim defaults to usual and customary pricing, which may be significantly lower than contracted rates for neighboring practices. Tracking payer-specific fee schedules within your billing system helps identify renegotiation opportunities.

Reduce claim denials for CPT 98940

Pabau's claims management tools help chiropractic practices track AT modifier requirements, link ICD-10 diagnoses to treatment regions, and flag missing documentation before submission.

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Common denial reasons and how to prevent them

Claim denials for 98940 cluster around a handful of recurring errors. Identifying the pattern in your practice’s remittance advice is the first step toward reducing write-offs.

• Missing AT modifier: The most common Medicare denial. Implement a billing rule that flags any 98940 claim line without AT before transmission. Automated billing workflows in practice management software can enforce this at claim creation.
• Wrong specialty code: Only specialty code 35 (Chiropractor) may bill CMT codes under Medicare. If a supervising physician submits on behalf of a DC without correct specialty enrollment, all claims are denied.
• Region count mismatch: Billing 98940 when the SOAP note documents three or more regions manipulated creates an audit exposure. Code selection must match the documentation exactly.
• Maintenance care without AT: Billing maintenance visits with the AT modifier and calling them active care is fraud. Distinguish active from maintenance clearly in each note.
• Unsupported diagnosis: Submitting a symptom-only ICD-10 code (e.g., M54.50 alone) without a subluxation code on a Medicare claim weakens medical necessity, especially during review.

Using automated billing workflows that check modifier presence, diagnosis-to-procedure alignment, and specialty code validity before claim submission reduces denial rates without requiring manual review of every claim.

Same-day billing: what can and cannot be billed

Medicare limits chiropractic coverage to manual spinal manipulation only. On the same date a chiropractor bills 98940 under Medicare, the following services cannot be billed to Medicare as separate payable services: therapeutic procedures (97110, 97112, 97140), physical modalities (97035, 97010), E/M visits, and extraspinal manipulation (98943).

This does not mean these services cannot be performed. It means Medicare will not pay for them alongside 98940. Patients may pay out-of-pocket for non-covered services on the same day, provided the practice uses an Advance Beneficiary Notice (ABN) correctly and the patient signs before service delivery.

Private payer policies on same-day billing vary significantly. Some commercial plans allow 98940 with 97140 (manual therapy) on the same day when performed by a qualified provider and documented as distinct services. Verify payer-specific bundling rules before billing combinations. Proper compliance management tools within your practice system can store payer-specific bundling rules and alert billing staff when a claim combination falls outside policy.

When billing both spinal and extraspinal CMT on the same date for non-Medicare payers, report the appropriate spinal code (98940, 98941, or 98942) and 98943 separately on the claim, with documentation distinguishing the regions and techniques used for each.

Conclusion

The most expensive billing mistake in chiropractic is a missing AT modifier: one field, one denial, and a claim that should have been paid. Beyond the modifier, accurate 98940 billing comes down to two fundamentals: region-specific documentation in every SOAP note and ICD-10 codes that match the clinical findings and the region treated.

Pabau’s practice management platform helps chiropractic practices standardize documentation templates, automate modifier checks, and submit cleaner claims with less manual review. To see how Pabau handles chiropractic billing workflows from intake to claim submission, book a demo.

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Need a ready-to-use intake form for your chiropractic patients? Chiropractic Intake Form Template provides a structured, downloadable template covering chief complaint, regional symptoms, and medical history.

Want to reduce claim errors across your entire billing workflow? Claims Management Software from Pabau automates modifier checks, diagnosis alignment, and claim status tracking in one place.

Looking for a related billing reference for broader spinal treatment visits? CPT Code 98941 billing guide covers documentation and payer rules for chiropractic manipulation of 3-4 spinal regions.

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