CPT 98942
Global 000 ActiveChiropractic manj 5 regions
CPT 98942 Billing & Documentation Guide
CPT code 98942 (Chiropractic manj 5 regions) is classified under Chiropractic with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.94, a non-facility practice expense RVU of 0.54, and a malpractice RVU of 0.01, a total non-facility RVU of 1.49 and facility RVU of 1.14. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $51.15, though rates vary from $47.06 to $66.49 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 98942, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 98942 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 98942 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 98942
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.94 | 0.94 |
| Practice Expense RVU | 0.54 | 0.19 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 1.49 | 1.14 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 98942
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $54.05 | $40.21 | $51.88 - $61.04 | 29 |
| Florida | $50.14 | $38.42 | $49.14 - $51.02 | 3 |
| Georgia | $49.05 | $37.9 | $47.88 - $50.22 | 2 |
| Illinois | $49.57 | $38.28 | $48.39 - $50.73 | 4 |
| Michigan | $48.81 | $37.83 | $48.24 - $49.37 | 2 |
| North Carolina | $48.44 | $37.53 | $48.44 - $48.44 | 1 |
| New York | $53.46 | $40.42 | $48.77 - $55.47 | 5 |
| Ohio | $48.2 | $37.53 | $48.2 - $48.2 | 1 |
| Pennsylvania | $49.71 | $38.25 | $48.27 - $51.14 | 2 |
| Texas | $49.64 | $38.13 | $48.12 - $50.84 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 98942
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 98942 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00640 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 36000 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36400 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36405 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36406 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36410 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36420 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36425 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36430 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36440 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 98942
What does CPT code 98942 mean? +
CPT code 98942 represents: Chiropractic manj 5 regions. It's in the Chiropractic category with a global period of 000.
What is the Medicare reimbursement for CPT 98942? +
The 2026 Medicare national average non-facility payment for CPT 98942 is $51.15. Rates range from $47.06 to $66.49 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 98942? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 98942? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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