98940: Chiropractic manipulative treatment, spinal, one to two regions
Category: Spinal CMT
By Dr. Daniel Turner, DC · Reviewed September 2, 2026
What is 98940 used for?
The base spinal adjustment code, used when chiropractic manipulative treatment addresses one or two of the five spinal regions (cervical, thoracic, lumbar, sacral, and pelvic).
How it works in a chiropractic practice
The workhorse for focused complaints: an acute cervical case, an isolated lumbar flare. The region count on the claim must match the regions documented as both subluxated and treated, which is where most 98940 problems start. Upcoding pressure runs the other way; billing 98941 when only two regions were genuinely assessed and treated is one of the fastest audit magnets in chiropractic.
What the note must show
- ✓The regions treated, with the subluxation findings supporting each
- ✓For Medicare, a subluxation demonstrated by X-ray or by physical examination, with the PART criteria the accepted exam framework
- ✓A treatment plan tying the manipulation to functional goals
- ✓For Medicare active care, the AT modifier on the line
A worked example
A patient presents with cervical pain after a rear end collision. The exam documents subluxation findings at C5 and C6 only. The correct code is 98940 with a cervical diagnosis. Billing 98941 because the doctor also briefly checked the thoracic spine, without documented findings and treatment there, turns a clean visit into an upcoding finding in a records review.
What the authorities say
Chiropractic claims draw exceptional scrutiny: the HHS Office of Inspector General reported chiropractic services carry the highest improper payment rate among Medicare Part B services, driven largely by maintenance care billed as active treatment and by documentation that does not support what was billed.
Billing 98940 with other codes on the same visit
- ✓Untimed: one unit per visit regardless of how long the adjustment took, and never more than one CMT code per day
- ✓With 97140 manual therapy same day: NCCI bundles the pair, so 97140 needs the distinct service modifier and a different region documented
- ✓With an E/M exam same day: the exam needs modifier 25 and its own documentation beyond the routine pre adjustment assessment
- ✓With 98943 extraspinal same day: allowed when both spinal and extraspinal work were performed and separately documented, each pointed at its own diagnosis
Does Medicare pay chiropractors for 98940?
Medicare covers spinal CMT codes and nothing else billed by a chiropractor. Active treatment requires the AT modifier; maintenance care requires an ABN and the GA modifier with the patient paying. The coverage rules live in the Benefit Policy Manual, Chapter 15, section 240.
Where practices get burned
Region counts that do not match the documented findings; missing AT on Medicare claims; diagnosis pointers that do not cover the regions billed.
How Cervica helps with 98940
Cervica's claim scrubber validates modifiers, units, and diagnosis pointers for 98940 before submission, per payer rules handle code substitutions and modifier requirements automatically, and when a payer pushes back anyway the denial worklist reads the adjustment codes and routes the claim to the exact fix.
Related codes
- →98941 · Chiropractic manipulative treatment, spinal, three to four regions
- →98942 · Chiropractic manipulative treatment, spinal, five regions
- →98943 · Chiropractic manipulative treatment, extraspinal
- →AT modifier · Active treatment modifier for Medicare CMT
- →GA modifier · Waiver of liability statement on file
- →CO-16 · the denial this code most often triggers
- →CO-11 · the denial this code most often triggers
- →CO-50 · the denial this code most often triggers
Quick answers
What is 98940 used for?
The base spinal adjustment code, used when chiropractic manipulative treatment addresses one or two of the five spinal regions (cervical, thoracic, lumbar, sacral, and pelvic).
What documentation does 98940 require?
The regions treated, with the subluxation findings supporting each For Medicare, a subluxation demonstrated by X-ray or by physical examination, with the PART criteria the accepted exam framework A treatment plan tying the manipulation to functional goals For Medicare active care, the AT modifier on the line
Does Medicare pay chiropractors for 98940?
Medicare covers spinal CMT codes and nothing else billed by a chiropractor. Active treatment requires the AT modifier; maintenance care requires an ABN and the GA modifier with the patient paying. The coverage rules live in the Benefit Policy Manual, Chapter 15, section 240.
References
- CMS, Medicare Benefit Policy Manual, Chapter 15 (chiropractic coverage, section 240)
- CMS, Medicare Claims Processing Manual, Chapter 12 (chiropractic billing, section 220)
- HHS Office of Inspector General, OEI-01-14-00200: CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services (September 2015)
General information for billing teams, not legal, coding, or payer specific advice. CPT is a registered trademark of the American Medical Association; code descriptions here are paraphrased in our own words and the AMA's CPT publications control. Payer policies vary and control for any individual claim.