Chiropractic Billing Cheat Sheet (2026)
Chiropractic billing has a hard line Medicare draws and most denials sit on: only spinal manipulation is covered, and only when it is active treatment, not maintenance. The AT modifier is how you assert that, and the region count sets the code.
Quick reference for chiropractic billers. Last updated .
Top Chiropractic CPT Codes & 2026 Medicare Allowables
| Code | Description | Non-Facility | Facility | Total RVU |
|---|---|---|---|---|
| 98940 | Chiropractic manipulative treatment, spinal, 1-2 regions | $26.72 | $18.37 | 0.80 |
| 98941 | Chiropractic manipulative treatment, spinal, 3-4 regions | $38.41 | $28.06 | 1.15 |
| 98942 | Chiropractic manipulative treatment, spinal, 5 regions | $49.77 | $38.08 | 1.49 |
| 98943 | Chiropractic manipulative treatment, extraspinal, 1+ regions | $26.39 | $19.37 | 0.79 |
| 97110 | Therapeutic exercise, 15 minutes | $29.06 | $29.06 | 0.87 |
| 97140 | Manual therapy techniques, 15 minutes | $27.72 | $27.72 | 0.83 |
| 97014 | Electrical stimulation, unattended | $12.69 | $12.69 | 0.38 |
| 97035 | Ultrasound therapy, 15 minutes | $14.36 | $14.36 | 0.43 |
| 72100 | X-ray lumbar spine, two or three views | $40.42 | $40.42 | 1.21 |
| 99213 | Established patient office visit, low MDM | $95.19 | $57.45 | 2.85 |
National 2026 Medicare Physician Fee Schedule estimates (total RVU multiplied by the conversion factor). These are adjusted by state locality. See the per-state table on the Chiropractic billing services page.
Modifiers That Prevent Chiropractic Denials
Active or corrective treatment on a covered spinal manipulation (98940 to 98942). Medicare denies manipulation billed without AT as maintenance.
An ABN is on file for maintenance care or non-covered services, preserving the ability to bill the patient.
A service expected to be denied as not reasonable and necessary with no ABN on file, signaling no patient liability.
A significant, separately identifiable E/M on the same day as the manipulation, documented distinctly. Many payers scrutinize this heavily for chiropractic.
A distinct service separate from the manipulation where the payer covers it and NCCI would otherwise bundle.
Therapy services under a therapy plan of care where a payer (not Medicare) covers them for chiropractic.
Top Chiropractic Denials → Quick Fix
Append modifier AT and document the active treatment plan with functional goals and expected improvement. Manipulation without AT reads as non-covered maintenance to Medicare.
Medicare covers only spinal manipulation for chiropractors. 97110, 97140, 97014, and similar are non-covered for DCs; collect via ABN with modifier GA or do not bill Medicare.
98940 is one to two regions, 98941 is three to four, 98942 is five. The exam must document the spinal regions treated to support the code.
Append modifier 25 and document an E/M distinct from the pre-manipulation assessment that is part of every CMT.
Medicare does not cover chiropractor-ordered or performed X-rays for manipulation. Do not bill it to Medicare; handle per the patient's other coverage or self-pay.
NCCI Bundling Watch-Outs
Code pairs from this specialty's set that carry NCCI edits. Billing both without a justified modifier triggers a bundling denial.
| Code | Bundles With | Rationale |
|---|---|---|
| 98940 | 00640 | Anesthesia service included in surgical procedure |
| 98940 | 36591 | CPT Manual or CMS manual coding instruction |
| 98941 | 00640 | Anesthesia service included in surgical procedure |
| 98941 | 36591 | CPT Manual or CMS manual coding instruction |
| 98942 | 00640 | Anesthesia service included in surgical procedure |
| 98942 | 36591 | CPT Manual or CMS manual coding instruction |
| 98943 | 36591 | CPT Manual or CMS manual coding instruction |
| 98943 | 36592 | CPT Manual or CMS manual coding instruction |
Documentation That Holds Up on Appeal
The specific spinal regions treated, since the code is region-count based, and the subluxation by exam or imaging where required.
A treatment plan with functional goals, measurable improvement, and an expected endpoint, supporting the AT modifier.
That the care is maintenance, with an ABN on file and modifier GA, so the patient liability is established.
An evaluation distinct from the brief pre-manipulation assessment inherent to every CMT, supporting modifier 25.
The extraspinal region treated and the medical necessity, separate from spinal CMT.
Revenue Chiropractic Practices Leave on the Table
Billing manipulation without AT and having covered active care denied as maintenance.
Billing modalities to Medicare that it never covers for chiropractors, instead of collecting via ABN.
Under-counting treated regions and coding 98940 when the exam supports 98941 or 98942.
Skipping modifier 25 on a documented separate E/M and losing the visit into the CMT.
Chiropractic Billing FAQ
What does the AT modifier do?
It tells Medicare the manipulation is active or corrective treatment, not maintenance. Medicare covers spinal manipulation only when it is active care, so a covered manipulation billed without AT is denied as maintenance.
What does Medicare cover for chiropractic?
Only manual spinal manipulation to correct a subluxation (98940 to 98942). Therapies, modalities, exams, and X-rays performed or ordered by the chiropractor are not covered by Medicare; collect those via ABN where appropriate.
How is the CMT code chosen?
By the number of spinal regions treated: 98940 for one to two, 98941 for three to four, 98942 for five. The documented exam has to support the regions billed.
Can I bill an E/M with the manipulation?
Only when it is significant and separately identifiable beyond the brief assessment built into every CMT, with modifier 25 and a distinct note. Payers scrutinize this closely for chiropractic.
Stop Losing Chiropractic Revenue to Preventable Denials
Our AAPC-certified chiropractic coders apply every rule on this sheet to your claims. Call 888-701-6090 for a free billing assessment.