Chiropractic Billing & Coding Guide
CMT 98940-98942 spinal regions, AT modifier for active treatment, secondary diagnosis required.
Common Chiropractic CPT Codes
Ranked by claim frequency, with current MPFS work RVUs and global periods.
| Code | Description | Work RVU | Total RVU | Global |
|---|---|---|---|---|
| 98940 | Chiropract manj 1-2 regions | 0.45 | 0.80 | 000 |
| 98941 | Chiropract manj 3-4 regions | 0.69 | 1.15 | 000 |
| 98942 | Chiropractic manj 5 regions | 0.94 | 1.49 | 000 |
| 98943 | Chiropract manj xtrspinl 1/> | 0.45 | 0.79 | XXX |
| 97010 | Hot or cold packs therapy | 0.06 | 0.20 | XXX |
| 97012 | Mechanical traction therapy | 0.24 | 0.43 | XXX |
| 97014 | Electric stimulation therapy | 0.18 | 0.38 | XXX |
| 97026 | Infrared therapy | 0.06 | 0.20 | XXX |
| 97035 | App mdlty 1+ultrasound ea 15 | 0.21 | 0.43 | XXX |
| 97110 | Therapeutic exercises | 0.45 | 0.87 | XXX |
| 97112 | Neuromuscular reeducation | 0.50 | 0.98 | XXX |
| 97140 | Manual therapy 1/> regions | 0.43 | 0.83 | XXX |
| 97530 | Therapeutic activities | 0.44 | 1.05 | XXX |
| 99202 | Office o/p new sf 15 min | 0.93 | 2.25 | XXX |
| 99203 | Office o/p new low 30 min | 1.60 | 3.52 | XXX |
| 99204 | Office o/p new mod 45 min | 2.60 | 5.31 | XXX |
| 99213 | Office o/p est low 20 min | 1.30 | 2.85 | XXX |
| 99214 | Office o/p est mod 30 min | 1.92 | 4.06 | XXX |
| 97799 | Unlisted physcl med/rehab px | 0.00 | 0.00 | XXX |
| 97039 | Unlisted modality | 0.00 | 0.00 | XXX |
What Chiropractic practices are leaving on the table
High-value services that consistently get under-billed across the specialty. Each one is rooted in current 2026 fee schedule and policy updates.
Modifier 25 on E/M services: Practices routinely undercode or omit separate E/M on manipulation days. If 20-25% of manipulation sessions have distinct clinical decisions, adding 99213 (est. $40-60 allowed) 4x/week = $8k-12k annual missed revenue. Workflow: train front desk to flag 'new findings' visits for clinical staff to document separately.
Modality bundling via regional separation: Practices apply 97010 (heat) then 97014 (E-stim) to same region and bill one code. If cervical and lumbar treated, two modality codes with modifier 59 per region yield $15-30 additional per session. Audit-safe with regional documentation.
Code level accuracy on manipulation: Many billers reflexively code 98941 for all sessions. Practices performing 5-region manipulation (spinal + multiple extremity) should verify 98942 eligibility (est. $25-40 higher allowed per session). Annual impact for 50-visit cycle = $1.2k-2k.
Neuromuscular reeducation (97112) for post-manipulation proprioceptive training: Rarely billed but medically defensible when patient presents with stability deficits (balance issues, proprioceptive loss post-injury). Adds $30-50/session. Documentation requirement: functional assessment showing proprioceptive deficit pre/post, tied to neuro exam.
Code pairs that auto-bundle to CO-97
From the National Correct Coding Initiative for Chiropractic. The rationale tells you when a modifier legitimately bypasses the edit and when it cannot.
Manual therapy (97140) bundles into chiropractic manipulation (98940) per NCCI guidelines. Modifier 59 is NOT appropriate here because 97140 is inclusive of the manipulative work. Document separate anatomic region or distinct time period to justify separate billing, otherwise expect RAC denial on 97140.
Therapeutic exercises and neuromuscular reeducation both address motor control in the same treatment episode. Cannot bill both same day without modifier 59 and documentation showing distinct treatment goals (e.g., exercises for ROM, reeducation for proprioception). Otherwise bundled.
Established patient E/M (99213) with manipulation (98941) on same day does NOT require modifier 25 if E/M is integral to manipulation decision. If separate, distinct evaluation occurred, use modifier 25 and document separately with different medical necessity. Without 25, E/M gets denied as included in global.
Modality codes (hot/cold packs 97010 and E-stim 97014) are often unbundled when applied to different body regions or treatment phases, but same-region same-session typically bundles. Modifier 59 requires documentation that modalities addressed separate clinical problems, not just sequential application.
Modifier Guidance for Chiropractic
When each modifier legitimately applies in this specialty, with denial-pattern context and audit-defense documentation.
Modifier 25 appended to E/M code (e.g., 99213-25) when a significant, separately identifiable evaluation occurs on same day as manipulation. Example: Patient presents with acute cervical strain (new neuro findings, full history), then receives 98941 for manipulation. The 25-minute office visit and manipulation are distinct services. Documentation must show separate decision-making, not just 'checked patient before adjustment.'
Modifier 59 on second/third procedure code indicates distinct procedural service normally bundled. In Chiropractic, this applies to modalities when applied to separate anatomic regions same day (e.g., 97014 to cervical, 97010 to lumbar). Requires clear documentation in treatment plan and clinical notes showing separate clinical rationale. Overuse triggers RAC audits.
Modifier GP ('Services delivered under outpatient physical therapy plan of care') is NOT appropriate for Chiropractic-rendered services. Chiropractors use 98940-98942 codes which are global procedure codes. Appending GP creates claim confusion and potential denial. Use only when services are actually delegated to/billed by PT.
Documentation requirements
What needs to live in the encounter note for these codes to survive a payer audit.
- Specific body regions manipulated in each session (cervical, thoracic, lumbar, pelvis, extremity) to justify code level 98940 vs 98941 vs 98942, since RACs correlate code frequency to anatomic specificity.
- Separate chart entry timestamp and distinct clinical note for E/M vs manipulation when both billed same day, to defend modifier 25 against 'bundled service' denials.
- Treatment plan with measurable goals (ROM improvement, pain reduction, functional gains) tied to each CPT code billed, as CMS LCDs require medical necessity beyond symptom coding.
- Duration of each modality (e.g., '15 min ultrasound,' '20 min E-stim') because 97035 is per 15-minute interval and unbilled partial units trigger frequency audits.
- Prior authorization number or ABN on file (modifier GA) when billing investigational/high-frequency modalities to commercial payers, reducing post-denial appeal burden.
- Patient functional capacity before/after each treatment episode (gait, grip, ROM), linked to CPT codes, because payer medical directors scrutinize outcomes correlation to justify ongoing frequency.
OIG and audit triggers in Chiropractic
Patterns that show up in OIG Work Plans, RAC audits, and CERT improper payment reviews. Build internal compliance checks around these.
OIG Work Plan 2025-2026 targets high-frequency manipulation (98941/98942 billed >2x/week for 12+ weeks) without measurable outcome improvement. Defend with baseline/interim/discharge functional metrics (ROM, pain scale, Oswestry) in chart. Payers increasingly correlate frequency to outcome documentation.
RAC Pattern: Bundling 97110 (exercises) and 97112 (neuro reeducation) same session without modifier 59 or distinct clinical notes results in 40-60% recoupment rates on second code. Solution: separate time blocks in chart and document different treatment objectives per CPT descriptor.
CMS LCD enforcement for Chiropractic under some Medicare contractors (e.g., Novitas in Texas/Oklahoma) restricts manipulation frequency to 2x/week unless imaging or specialist referral documented. Non-compliance triggers pre-payment edits and recoupment notices.
Modality overutilization audits focus on 97035 (ultrasound) billed without justification for therapeutic vs comfort intent. Document clinical reasoning (tissue healing, pain gate modulation) tied to diagnosis, not reflexive application.
Payer-specific billing notes
Where the major payers diverge from generic Medicare rules in Chiropractic.
ME Medicare +
CMS NCD 20.1 (Chiropractic Services) allows treatment of subluxation only; subluxation must be documented per payer MAC rules (e.g., Novitas, Palmetto). Most MACs require X-ray or MRI evidence. Frequency limits vary by MAC (Palmetto: 12-15 visits/90 days for initial complaint, then re-eval required). Prior auth not federally required but contractor-specific policies (e.g., United Healthcare Medicare Advantage) may mandate it. 2026 CMS guidance emphasizes outcome measurement for continued coverage.
UN UnitedHealthcare +
Optum-delegated plans enforce 20-visit annual chiropractic benefit limit in many regions, with prior auth required after visit 10. No bundling restriction on modalities within plan, but E/M same day as manipulation requires modifier 25 to avoid service-based benefit reduction. Chiropractic subluxation must be coded as ICD-10 M99.xx or claim auto-denies at UHC medical policy filter.
AN Anthem +
Anthem ICR/AMBA prior auth required for plans in CA, NY, TX for chiropractic >15 visits/year. No regional bundling restrictions on modalities. Medical policy restricts E/M billing on manipulation days unless modifier 25 is appended and separate clinical decision documented (e.g., new neuro exam). Denial reason code 'included in global' common without modifier 25.
CI Cigna +
Cigna eviCore does not typically delegate chiropractic (unlike radiology), so internal medical policy governs. Cigna regional plans often limit manipulation to 10 visits/calendar year. No CPT bundling restrictions in most plans, but medical policy denies modalities lacking active ROM improvement correlation. Recommend outcome documentation per episode (initial, mid-treatment, discharge functional metrics).
Standard Chiropractic coding workflow
Step 1: On check-in, capture chief complaint, prior visit date, and body regions to be treated to predetermine 98940 (1-2 regions), 98941 (3-4), or 98942 (5 regions). Step 2: If patient has distinct neuro/ROM/functional findings NOT documented at last visit, create separate E/M note (99213 or 99214) before manipulation and flag for modifier 25. Step 3: During treatment, log each modality code with duration (15-min intervals for 97035) and specific body region to permit bundling audit trail. Step 4: Append modifiers per NCCI (modifier 59 only if separate region/distinct problem), verify zero bundling partners in AvoidEdit database, then batch transmit. Step 5: Post-denial, cross-reference CARC codes to treatment plan documentation; if missing regional specificity or timestamps, amend chart before appeal.
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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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