Chiropractic manipulative treatment of one or two spinal regions in a single visit, used when the chiropractor adjusts a limited area such as the cervical or lumbar spine.
- Medicare
- $26.72
- Work RVU
- 0.45
- Global, days
- 0
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Level of subluxation for each spinal region treated, tied to the matching M99.0x diagnosis
- PART findings: pain, asymmetry or misalignment, range of motion change, and tissue or tone change
- Treatment plan with goals, frequency, and expected duration
- Progress toward goals at each visit, showing the care is active and not maintenance
- Regions actually adjusted that day, which drive the code level
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
98940 covers spinal manipulation by a chiropractor in one or two of the five spinal regions: cervical, thoracic, lumbar, sacral, and pelvic. Orthopedic groups that employ or co-locate a chiropractor usually see this code with neck or low back pain patients who are being managed without surgery.
Medicare pays chiropractors only for manual manipulation of the spine to correct a subluxation. The subluxation can be shown by X-ray or by physical exam using PART findings. Active, corrective treatment needs the AT modifier. Without it, Medicare treats the visit as maintenance and denies it. If you expect a maintenance denial, have the patient sign an ABN and use GA.
Commercial plans often cap visits per year and may require prior authorization after a set number. Track counts before the visit, not after the denial.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (0.45) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (0.8) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.45 |
| Practice expense RVU | 0.34 |
| Malpractice RVU | 0.01 |
| Total RVU | 0.8 |
| Medicare national rate | $26.72 |
| Global period | 0 days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $26.72 |
HOPD (APC 5811) Hospital outpatient department | $22.06 |
Common denial reasons
The recurring reasons claims for CPT 98940 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing AT modifier on Medicare claims for active corrective treatment
- Primary diagnosis is not a subluxation code (M99.0x) when Medicare requires it
- Notes read as maintenance care with no functional improvement
- Region count does not support the code billed
- Commercial plan visit limit for chiropractic exhausted
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01What is CPT 98940?
02Does Medicare require the AT modifier on 98940?
03What diagnosis should be primary for 98940 on Medicare?
04Is an X-ray required for 98940?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe records the findings for each spinal region adjusted and the patient's progress against the plan, which is what reviewers look for on 1 to 2 region claims.
See how Mira captures CPT 98940 documentation