CPT 98940
Chiropractic Manipulation, 1-2 Regions
How it is billed
- Region count, not adjustment count: two adjustments in one region is still one region, and this code covers one or two
- Medicare covers manual manipulation of the spine to correct a subluxation and nothing else — no extraspinal manipulation, no therapies, no examinations
- Medicare requires the active treatment modifier to indicate corrective rather than maintenance care; without it the claim is treated as maintenance and denied
- Maintenance care is a non-covered service for Medicare, which makes an advance beneficiary notice and the corresponding modifier the mechanism for billing the patient
- An evaluation and management service on the same day requires modifier 25 and a separately identifiable reason beyond the pre-manipulation assessment
What the record must show
- The initial visit must establish the subluxation, the levels involved, and a treatment plan with measurable goals and a frequency and duration
- Each subsequent visit needs the standard assessment findings and the patient's response to treatment, showing progression toward the plan's goals rather than a static record repeated visit to visit
- The specific regions treated must be identifiable in the note, since the region count is the entire basis of code selection
A worked example
A patient presents with neck pain and upper back tightness. The examination documents subluxation in the cervical and thoracic regions, and both are adjusted. Two regions, so 98940 is correct.
Three weeks later the patient's lumbar spine becomes symptomatic and is documented and treated as well. That visit is three regions and moves to the next code up — the change is driven by the documented examination, not by the length of the visit or the number of thrusts.
Once the treatment plan's goals are met and the patient continues attending to maintain function, the care becomes maintenance. For Medicare that is non-covered: the visit is billed with an advance beneficiary notice on file and the modifier indicating a signed notice, which shifts the balance to the patient rather than producing an unexpected write-off.
What decides payment
Chiropractic is one of the most heavily reviewed services in Medicare, and the reason is documentation rather than clinical merit. The requirement to distinguish active corrective treatment from maintenance is easy to state and easy to fail, because a note that looks the same in week two and week twenty demonstrates maintenance by its own repetition.
The region-count structure creates a visible distribution: three codes covering one or two, three or four, and five regions. A practice reporting the middle code almost exclusively is the pattern most often selected for review, and the answer is examination findings that actually vary by patient.
Coverage outside Medicare varies sharply. Many commercial plans cover therapies and examinations that Medicare excludes, and several impose visit caps or require authorisation after a set number — so the same clinical course is billed differently by payer, and verifying which applies before the plan is written is what prevents mid-course denials.
Denials this code attracts
Modifiers that apply
Codes billed alongside or confused with this one
Billed most in — Chiropractic · Physical Therapy · Pain Management
Terms used here — Medical Necessity · Denial · Modifier · Patient Responsibility
How we handle it — Medical Coding · Denial Management · Eligibility Verification
Primary sources
What the code-set maintainers and payers actually publish about billing 98940.
- Medicare Benefit Policy Manual (opens in a new tab)
Centers for Medicare & Medicaid Services — What Medicare covers and under what conditions, as distinct from how a claim is processed. The starting point for any coverage or medical necessity question.
- Advance Beneficiary Notice of Noncoverage (ABN) (opens in a new tab)
Centers for Medicare & Medicaid Services — The form and the rules for issuing it. Whether a non-covered service can be billed to the patient usually turns on whether a valid ABN was obtained beforehand.
- Medicare Coverage Database (LCD/NCD) (opens in a new tab)
Centers for Medicare & Medicaid Services — Searchable national and local coverage determinations. The direct answer to whether a diagnosis supports medical necessity for a given procedure.
Questions about CPT 98940
Chiropractic manipulative treatment of one or two spinal regions. The five spinal regions are cervical, thoracic, lumbar, sacral and pelvic, and the number of regions treated selects the code.
No. Code selection is by region count, not by how many adjustments were performed. Two adjustments within the cervical region is still one region and still this code.
Only manual manipulation of the spine to correct a subluxation, and only where the treatment is active and corrective. Examinations, therapies and extraspinal manipulation are not covered, and maintenance care is excluded.
As a non-covered service, with an advance beneficiary notice signed before the visit and the modifier indicating that a notice is on file. That makes the patient responsible rather than producing an unexpected write-off.
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