Chiropractic CPT Codes Explained: 98940–98943 

Chiropractic CPT codes center on one primary procedure category — Chiropractic Manipulative Treatment (CMT), reported under CPT 98940-98942. These codes describe spinal manipulation by the number of regions treated, and they drive the majority of chiropractic billing revenue. 

Beyond CMT, chiropractors may also bill evaluation and management (E/M) visits, therapeutic procedures (97110, 97140), and physical medicine modalities (97035, 97014), though payer coverage for services beyond spinal manipulation varies significantly — especially under Medicare, which typically covers only CMT for documented subluxation.

The billing challenge in chiropractic isn’t code complexity — it’s the strict documentation and payer rules that govern whether each code actually pays. A correct CPT code paired with insufficient documentation, a missing modifier, or the wrong diagnosis link produces the same result as a wrong code: a denied claim.

Let’s explore:

• Documentation requirements that prevent denials
• E/M billing rules and modifier 25 for same-day visits
• Medicare coverage restrictions vs commercial payer rules
• Therapeutic procedure and modality codes chiropractors use
• Common chiropractic billing mistakes and the denial codes they trigger
• CMT codes 98940-98943 and how spinal regions determine code selection

What are the CMT codes and how do spinal regions work?

Chiropractic Manipulative Treatment codes describe spinal adjustment by the number of regions treated during the encounter — not the number of individual adjustments or techniques applied. AMA CPT defines five spinal regions for CMT coding purposes.

The five spinal regions are cervical (including atlanto-occipital), thoracic, lumbar, sacral, and pelvic. Each region treated during the visit counts toward the total that determines the CPT code.

The most common billing mistake in CMT coding — selecting the code based on the number of adjustments rather than the number of regions. 

A chiropractor who performs three adjustments in the lumbar region has treated one region (lumbar), not three. CPT 98940 applies. 

Conversely, adjusting the cervical, thoracic, and lumbar spine — even with one adjustment per region — constitutes three regions and supports CPT 98941.

CPT 98943 describes extraspinal manipulation (extremities, ribs, temporomandibular joint). It’s billed separately from the spinal CMT codes and can be reported on the same visit. 

However, Medicare does not cover 98943 — only commercial payers and some Medicaid plans reimburse extraspinal manipulation.

Which therapeutic procedure codes do chiropractors use?

Beyond CMT, chiropractors frequently bill therapeutic procedures and physical medicine modalities. Coverage varies widely by payer — a code that pays under one commercial plan may deny under Medicare or another insurer.

CPT code	Description	Billing type	Medicare coverage
97110	Therapeutic exercises (strength, endurance, ROM)	Time-based (per 15 min)	Not covered under chiropractic benefit
97140	Manual therapy (mobilization, myofascial release)	Time-based (per 15 min)	Not covered under chiropractic benefit
97112	Neuromuscular reeducation (balance, posture, coordination)	Time-based (per 15 min)	Not covered under chiropractic benefit
97035	Ultrasound therapy	Time-based (per 15 min)	Not covered under chiropractic benefit
97010	Hot/cold packs	Untimed (per application)	Typically bundled/non-payable
G0283	Unattended electrical stimulation (Medicare)	Untimed	Medicare uses G0283 instead of CPT 97014

A critical distinction that affects every chiropractic practice’s billing — CPT 97014 (unattended electrical stimulation) is not separately payable under Medicare. Medicare uses HCPCS code G0283 instead. 

Practices that bill 97014 to Medicare will see the claim denied or zero-paid, and resubmitting with G0283 after the fact wastes time and risks timely filing issues.

Time-based codes (97110, 97140, 97112, 97035) require documented treatment time for each unit billed. One unit equals 15 minutes of direct treatment. 

The “8-minute rule” applies — services must meet the minimum time threshold (at least 8 minutes for one unit) to be billable. Documentation must record start and stop times or total treatment minutes for each code.

How does E/M billing work alongside chiropractic manipulation?

Chiropractic manipulation and evaluation and management (E/M) services can be billed on the same date of service, but only when the E/M visit represents a separate, medically necessary evaluation. 

Bill an E/M service only when it is separately identifiable

Chiropractors can bill E/M codes (99202–99215 for new and established patients) when a separately identifiable evaluation and management service is performed during the same visit as CMT. 

The key requirement is appending modifier 25 to the E/M code and documenting a distinct evaluation that goes beyond the standard assessment included in the manipulation service.

Distinguish routine care from separate clinical work

If the provider performs a focused exam, reviews the patient’s condition, adjusts the treatment plan, and performs the manipulation as part of a standard chiropractic visit, only the CMT code applies. 

If the provider also evaluates a new complaint, orders diagnostic studies, reviews significant new findings, or makes additional treatment decisions, the E/M service may be billed separately with modifier 25.

Monitor E/M billing patterns to reduce audit risk

Payer auditors closely examine chiropractic practices that report E/M services alongside CMT on a high percentage of visits. Consistently billing same-day E/M services—such as on more than 80% of CMT claims — can trigger audit scrutiny even when individual claims are properly documented.

What are the Medicare coverage rules for chiropractic services?

Medicare coverage for chiropractic care is much narrower than many providers expect. 

While spinal manipulation to correct subluxation is covered under specific circumstances, most other chiropractic services fall outside the Medicare benefit. 

Medicare only covers spinal manipulation for subluxation

Under Medicare Part B, chiropractic coverage is limited to manual spinal manipulation billed with CPT codes 98940, 98941, or 98942. Services outside this benefit cannot be billed to Medicare, including:

• Extraspinal adjustments
• Therapeutic modalities and physical therapy services
• Routine E/M services (unless separately covered under another benefit)

Use the AT modifier and document medical necessity

Medicare requires the AT modifier to indicate the patient is receiving active treatment rather than maintenance care. Claims submitted without the modifier are typically denied.

Documentation should also include:

• A diagnosis of spinal subluxation
• Evidence supporting the diagnosis through X-ray findings or physical examination criteria
• Medical necessity consistent with the applicable Local Coverage Determination (LCD)

Distinguish active treatment from maintenance care

The maintenance care exclusion is the most common reason Medicare denies chiropractic claims. CMS considers maintenance care to be treatment intended to prevent deterioration rather than improve an active condition.

Documentation should continue to demonstrate that:

• The patient is making measurable functional improvement
• Treatment addresses an acute or actively improving condition
• Progress supports ongoing medical necessity

If the record shows the patient has plateaued over multiple visits, Medicare may classify subsequent treatment as maintenance care and deny payment. 

Because LCD requirements vary by Medicare Administrative Contractor (MAC), providers should follow the documentation standards applicable to their region.

What documentation prevents chiropractic claim denials?

Chiropractic billing is more documentation-sensitive than most procedure categories because payers tie reimbursement directly to measurable clinical data — regions treated, subluxation findings, functional status, and treatment response.

Every chiropractic encounter should document

• Treatment goals and expected duration
• Patient response to treatment since last visit
• Spinal regions treated (by name, not just quantity)
• Technique used (diversified, Gonstead, activator, etc.)
• Subluxation diagnosis with supporting findings (for Medicare)
• Functional limitations and objective measurements (ROM, pain scale, ADL impact)
• ICD-10 diagnosis linked to the CPT code (M99.xx for subluxation, M54.5 for low back pain, M54.2 for cervicalgia)

For time-based codes (97110, 97140, 97112), the note must include total treatment time per code. For E/M visits billed same-day with CMT, separate documentation must support the E/M as a distinct service — not just a restatement of the manipulation evaluation.

What chiropractic billing mistakes cause denials?

Many chiropractic claim denials are preventable. These are the most common billing mistakes that trigger payer rejections and audits.

Using CPT 97014 instead of HCPCS G0283 for unattended electrical stimulation on Medicare claims is another persistent error. 

Medicare does not recognize 97014 for separate payment — G0283 is the correct code. 

Practices that have 97014 set as a default in their billing system will generate automatic denials on every Medicare claim that includes it.

Which modifiers matter most in chiropractic billing?

Three modifiers appear most frequently on chiropractic claims, and each has specific rules.

AT modifier

Required on all Medicare CMT claims to indicate active treatment. Without AT, Medicare denies the manipulation claim. The modifier signals that the patient is receiving treatment for an acute or actively improving condition, not maintenance care.

Modifier 25

Appended to the E/M code (not the CMT code) when a separately identifiable evaluation is performed on the same day as manipulation. Requires distinct documentation supporting the E/M as a separate service. Overuse triggers payer audit.

Modifier 59

Used when billing CMT and a therapeutic procedure (like 97140) that would otherwise bundle under NCCI edits, and the services are clinically distinct. CMS recommends using X-modifiers (XS, XE, XP, XU) when a more specific reason applies. Check NCCI edits for chiropractic code pairs before appending any unbundling modifier.

Chiropractic billing accuracy protects your revenue and your compliance

MedHeave operates as an embedded revenue cycle department inside medical practices, with AAPC-certified coders who validate CMT code selection against documented regions, verify modifier requirements per payer, and check Medicare coverage rules on every chiropractic claim before submission.

• 90%+ first-pass rate across all claim types
• Claims submitted within 24-48 hours of signed encounter notes
• Denials addressed within 72 hours with payer-specific appeal templates
• No lock-in agreements — 30-day exit, performance-based pricing (4-7%)
• Dedicated account managers with direct access (Monday-Friday, 9-5 EST)

If chiropractic billing denials are a recurring issue in your practice, contact MedHeave to see how structured coding and payer verification closes those gaps.

Frequently asked questions

Here are some commonly asked questions on this topic: