Chiropractic manipulation of one or more regions outside the spine, such as the shoulder, elbow, wrist, hip, knee, ankle, ribs, or jaw.
- Medicare
- $26.39
- Work RVU
- 0.45
- Global, days
- Region
- Multi-region
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Each extraspinal region treated and the joint involved
- Exam findings for the joint: restricted motion, pain, swelling, or tissue change
- Diagnosis for the extremity or rib condition, not only the spinal subluxation
- Technique and patient response
- Treatment plan goals for the extremity complaint
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 ↓
98943 reports chiropractic manipulation of extraspinal regions. The five extraspinal regions are head (including the TMJ but not the atlanto-occipital joint), lower extremities, upper extremities, rib cage (not the costovertebral or costotransverse joints), and abdomen. One code covers one or more regions, so it is billed once per visit.
Medicare does not cover 98943. Its status indicator is N, and Medicare pays chiropractors only for spinal manipulation. Bill it to Medicare only if the patient wants a denial for secondary insurance, and use GY to mark it as statutorily excluded. Many commercial plans do pay it, often counted against the same chiropractic visit limit.
In ortho practices this shows up with ankle sprains, shoulder impingement, and knee pain treated alongside spinal care. If billed with 98940 to 98942 on the same day, the spinal and extraspinal notes should describe different findings.
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 (0.79) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.45 |
| Practice expense RVU | 0.31 |
| Malpractice RVU | 0.03 |
| Total RVU | 0.79 |
| Medicare national rate | $26.39 |
| Global period | 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 | $26.39 |
Common denial reasons
The recurring reasons claims for CPT 98943 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Billed to Medicare, which excludes extraspinal chiropractic manipulation
- Billed more than once per visit for multiple extremities
- No extremity diagnosis on the claim, only spinal codes
- Commercial visit limit reached
- Same-day spinal and extraspinal notes are identical
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Does Medicare cover CPT 98943?
02Can 98943 be billed more than once per day?
03Can 98943 be billed with 98941 on the same day?
04Does TMJ manipulation use 98943?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe separates extremity findings from spinal findings in the note, so the 98943 work is clearly distinct from the same-day spinal adjustment.
See how Mira captures CPT 98943 documentation