Chiropractic CPT Codes 2026: Complete Guide to CMT Codes, Medicare Rules, Modifiers, and Denial Prevention

2026 Chiropractic CPT Codes: Quick Reference

For the full billing rules, modifier requirements, Medicare documentation standards, and denial prevention, see the guide below.

Chiropractic billing carries one of the highest improper payment rates in Medicare: 33.6%, according to CMS chiropractic improper payment data, with projected improper payments of $178.3 million. For a chiropractor, that number means roughly one in three claims is exposed before it ever reaches the payer.

Chiropractic CPT codes are the five-digit codes that decide what Medicare and commercial payers pay for every adjustment, modality, and evaluation you perform. These chiro CPT codes fall into four groups: manipulation, therapy, modality, and evaluation. Code selection is the line between payment and denial.

This guide covers the four CMT codes, AT modifier rules, therapy and modality codes, ICD-10 pairing, documentation standards, and the 2026 updates.

Andrew Christian, Billing Manager at MedSole RCM, built this reference from primary sources: CMS Billing Article A56273, the AMA CPT 2026 code set, and the CMS MLN chiropractic compliance tips updated February 2026. Providers who want the broader compliance picture can also review MedSole's chiropractic billing services guide.

The Four Chiropractic Manipulative Treatment Codes: 98940, 98941, 98942, and 98943 Explained

Chiropractic CPT codes for manipulative treatment are selected by one criterion: the number of spinal regions treated, not the number of adjustments performed. A chiropractor who performs three adjustments in the lumbar spine has treated one region, not three, and bills CPT 98940. Adjusting the cervical, thoracic, and lumbar spine bills CPT 98941.

CPT Code 98940: Chiropractic Manipulative Treatment, 1 to 2 Spinal Regions

CPT 98940 applies when a chiropractor manipulates one or two of the five spinal regions. Medicare covers it with the AT modifier for active care, at a 2026 non-facility rate of roughly $30 to $45. The common case is a cervical-plus-thoracic or lumbar-only visit. The note has to name the regions treated, not log “1 to 2 regions.”

CPT Code 98941: Chiropractic Manipulative Treatment, 3 to 4 Spinal Regions

CPT 98941 is the most commonly billed CMT code across chiropractic practices. It covers three or four spinal regions: cervical plus thoracic plus lumbar equals three regions, so it bills 98941. Medicare covers it with the AT modifier at a 2026 national average near $38, and commercial payers usually pay more. The note documents each treated region.

CPT Code 98942: Chiropractic Manipulative Treatment, 5 Spinal Regions

CPT 98942 covers all five spinal regions, and each region needs its own documented clinical findings. Medicare covers it with the AT modifier at a 2026 non-facility rate around $45 to $65. Billing 98942 on a high share of your Medicare CMT claims without documentation supporting all five regions is a pattern that contractors may flag for prepayment review.

CPT Code 98943: Extraspinal Chiropractic Manipulative Treatment

CPT 98943 covers manipulation of non-spinal joints: shoulders, knees, wrists, ribs, and the temporomandibular joint. Medicare doesn't cover 98943 under any circumstance, per CMS Billing Article A56273; append Modifier GY for a statutorily excluded service. Commercial coverage varies, so verify first. Billing 98943 with a spinal CMT code the same day needs Modifier 59 on 98943.

The AT Modifier: The Single Most Important Compliance Requirement for Medicare Chiropractic Billing

The AT modifier goes on every Medicare claim for CPT 98940, 98941, and 98942 when treatment is active and corrective instead of maintenance care. Omit it, and the Medicare Administrative Contractor denies the claim automatically, with no adjudication and no appeal pathway. The AT modifier is the gate every chiropractic Medicare claim passes through.

Complete Chiropractic Modifier Reference for 2026

These are the chiropractic CPT codes and modifiers that decide payment on a Medicare or commercial claim, with the consequence of leaving each one off.

Active treatment is care where measurable functional improvement is expected and documented. Maintenance therapy is care that holds the line after the patient reaches maximum therapeutic benefit. Medicare pays for the first and denies the second. The AT modifier tells Medicare the current visit is active treatment, which is why a missing AT denies the claim outright.

CMS sets the coverage authority in the CMS Medicare Benefit Policy Manual Chapter 15, and it lays out the documentation standards in its CMS chiropractic compliance tips. For the full PART documentation framework behind the AT modifier, see MedSole's chiropractic billing compliance guide.

Improper modifier use accounts for about 31% of chiropractic claim denials, by ACA data. When modifier errors drive denials in your practice, MedSole RCM's billing team reviews modifier assignment on every claim before submission, with chiropractic billing services at 2.99% of collections.

Active Treatment vs. Maintenance Therapy: The Distinction That Determines Whether Medicare Pays

Active treatment is corrective care where the patient hasn't reached maximum therapeutic benefit and measurable functional improvement is expected and documented at each visit. Maintenance therapy is care provided after maximum therapeutic benefit is reached, meant to prevent deterioration instead of producing further improvement.

When a patient reaches maximum therapeutic benefit, the chiropractor moves through four steps:

1. Stop using the AT modifier.
2. Obtain a signed Advance Beneficiary Notice before the next treatment.
3. Apply the GA modifier on claims for continued care, which signals the ABN is on file.
4. Tell the patient Medicare won't cover continued treatment.

Billing maintenance care as active treatment is a leading driver of OIG recoupment findings in chiropractic. The OIG chiropractic audit findings document hundreds of millions of dollars in unallowable chiropractic payments tied to this exact error.

Some commercial plans use code S8990 (a HCPCS maintenance-therapy code) for maintenance chiropractic care that Medicare excludes. Verify individual plan coverage before billing any maintenance visit.

Physical Medicine and Therapy CPT Codes Chiropractors Use Alongside CMT

Medicare doesn't cover physical medicine and rehabilitation codes billed by chiropractors under the chiropractic benefit, including CPT 97110, 97112, 97140, 97530, 97012, and 97035. Commercial payers may cover them. CMS sets the same-day bundling rules in the CMS NCCI Policy Manual. Bill any of these to Medicare under the chiropractic benefit, and the line returns an automatic denial.

These therapy and modality codes sit alongside the core chiropractic CPT codes a practice bills every day, and each one carries its own documentation rule.

For the NCCI edit table governing when 97140 and CMT bill together, see the complete CPT 97140 billing guide. For the 8-minute rule, the KX threshold, and the timed-code unit table, see physical therapy CPT codes 2026.

Documentation requirements and denial patterns for therapeutic exercise are in the CPT 97110 billing guide. Audit-ready standards for neuromuscular re-education are in the CPT 97112 complete billing reference. The 97110-versus-97530 distinction is covered in the CPT 97530 billing guide.

CPT 97012 (mechanical traction) applies a controlled pulling force that stretches the spine. Roller tables and intersegmental traction devices that create passive movement without sustained distraction are often billed under 97012 in error. The correct code for these units is typically 97039 (unlisted therapeutic modality), and the note has to describe the device and its purpose.

Billing 97012 for roller-table services is a common audit trigger.

G0283 vs. CPT 97014: The Most Common Medicare Billing Error in Chiropractic Practices

CPT 97014 (unattended electrical stimulation) is invalid on the Medicare Physician Fee Schedule and generates an automatic denial on every Medicare Part B outpatient claim. The correct code is HCPCS G0283. UnitedHealthcare follows the Medicare policy and also requires G0283 on outpatient therapy claims.

Billing systems that default to 97014 on all claims and don't route G0283 to Medicare accounts generate a denial on every Medicare electrical-stimulation claim. This isn't a single-claim error; it compounds across every Medicare patient until the billing system is corrected. Check your system's payer-specific code routing before the next submission cycle.

For the full G0283-versus-97014 comparison with every payer rule, modifier requirement, and reimbursement rate, see the 97014 billing rules and G0283 guide.

NCCI Edits and Modifier Rules: When Chiropractic Codes Bundle and How to Unbundle Them

The National Correct Coding Initiative (NCCI) edits, updated quarterly by CMS in the CMS NCCI Policy Manual Chapter XI, govern which chiropractic code combinations bundle by default and which unbundle with a modifier. Practices that bill CMT alongside therapy codes without checking NCCI edits generate bundling denials that don't surface as distinct rejections, hard to spot in the AR.

When you bill CPT 97140 the same day as a CMT code, the manual therapy has to target an anatomically separate region from the spinal manipulation.

A chiropractor who adjusts the lumbar spine (98940) and performs myofascial release on the right shoulder bills 98940 and 97140-59, with the note naming the right glenohumeral joint as the 97140 target. The same release on the lumbar spine makes 97140 part of the CMT, and the line denies, modifier or not.

Evaluation and Management CPT Codes for Chiropractors: When to Bill E/M Alongside Chiropractic CPT Codes

Chiropractors may bill evaluation and management CPT codes 99202 through 99215 when a significant, separately identifiable evaluation accompanies the manipulation. Medicare doesn't cover E/M services billed by chiropractors under the current chiropractic benefit, per the CMS Medicare Benefit Policy Manual Chapter 15 Section 240. Commercial payers usually cover same-day E/M with proper documentation and Modifier 25.

When a chiropractor performs a separately identifiable evaluation the same day as CMT, Modifier 25 goes on the E/M code, not the CMT code. Without it, the E/M bundles into the manipulation payment and is lost.

The evaluation has to read as a distinct service, with its own history, exam, and reasoning beyond the assessment built into CMT.

Billing E/M on a high share of CMT visits is a pattern that can trigger payer review, even when each individual claim is documented.

For the complexity criteria and same-day documentation rules, see the CPT 99202 billing guide. The CPT 99203 documentation reference covers complexity determination for new-patient evaluations in chiropractic and physical-medicine settings.

ICD-10 Diagnosis Codes for Chiropractic Claims: Primary Subluxation Codes and Secondary Symptom Codes

For Medicare chiropractic claims, CMS Billing Article A56273 requires the primary diagnosis to be a subluxation code from the M99.0x series naming the spinal region treated. The related condition, the back pain or cervicalgia or radiculopathy, goes secondary. Put a symptom code in the primary position instead, and Medicare denies every CMT claim, AT modifier or not.

Table 1: Primary Subluxation Codes for Medicare CMT Claims (M99.0x Series)

Table 2: Common Secondary Diagnosis Codes for Chiropractic Claims

Effective October 1, 2025, ICD-10 code M54.5 was deleted and split into three codes: M54.50 (low back pain, unspecified), M54.51 (vertebrogenic low back pain), and M54.59 (other low back pain), per the CMS ICD-10-CM FY2026 update.

Claims dated after September 30, 2025 that still carry M54.5 return automatic denials. Audit every superbill and EHR diagnosis pick-list for M54.5 and update it before the next billing cycle.

For the full M54 series with every specificity code and its documentation requirement, see the back pain ICD-10 code guide.

SOAP Note Documentation Requirements for Chiropractic Claims: What CMS Demands at Every Visit

By the CMS MLN Chiropractic Services compliance data updated February 2026, 95.5% of the 33.6% improper payment rate in chiropractic Medicare billing traces to one root cause: insufficient documentation. The clinical notes that support chiropractic CMT claims have to satisfy specific elements at the initial visit and at every visit after.

CMS requires documentation of at least two of the four PART elements, one of which has to be A or R, per CMS Billing Article A56273.

At every visit after the first, CMS expects the SOAP note to carry four updated elements:

Subjective: changes in the complaint since the last visit, and the current pain level on a validated scale.

Objective: exam findings for the spinal region treated, updated ROM measurements, and palpation results.

Assessment: patient progress toward defined functional goals, compared to the prior-visit baseline.

Plan: the rationale for continued treatment, with active care still expected to produce measurable improvement, and the next-visit frequency.

Top Chiropractic Claim Denial Reasons in 2026 and How to Prevent Each One

ACA and industry denial analyses put four categories at the top for chiropractic claims: medical-necessity documentation failures at about 38%, improper modifier use at about 31%, subluxation documentation errors at about 19%, and maintenance care billed as active treatment at about 12%. An OIG chiropractic audit found that 82% of reviewed Medicare chiropractic payments were unallowable.

Chiropractic billing carries a 33.6% improper payment rate under Medicare, which means one in three claims is at risk before it's submitted. Practices with the right workflow prevent most of these denials at the front end instead of appealing them after the fact.

MedSole RCM's team handles chiropractic CPT codes selection, modifier compliance, documentation pre-review, NCCI edit scrubbing, and subluxation diagnosis verification on every claim, with full-service billing at 2.99% of collections and credentialing at $99 per insurance. A free billing audit shows where the denials start.

Each denial type maps to a specific Claim Adjustment Reason Code. A missing AT modifier draws a CO-4 denial; Modifier 59 without distinct-region documentation draws a CO-97 denial; and documentation that doesn't establish clinical need draws a CO-50 denial, the most expensive category in chiropractic billing.

MedSole RCM's chiropractic denial management team identifies the root cause of each denial within 24 hours and resubmits corrected claims before the appeal window closes. Claims that stay unpaid past the initial window need active AR recovery follow-up to prevent a permanent write-off.

2026 Official Updates: AMA CPT Changes, New RTM Codes, ICD-10 FY2026, and Chiropractic Taxonomy Code

No new chiropractic manipulative treatment codes arrived in the AMA CPT 2026 code set. CPT 98940, 98941, 98942, and 98943 are unchanged. The AMA CPT 2026 release carries 418 total changes: 288 new codes, 84 deletions, and 46 revisions, concentrated in digital health, remote monitoring, and augmented-intelligence services.

1. New RTM codes for MSK care (effective January 1, 2026). Two new RTM codes apply to chiropractic practices monitoring musculoskeletal patients remotely. CPT 98985 covers RTM device supply over 2 to 15 days in a 30-day period. CPT 98979 covers the first 10 minutes of treatment management per calendar month, requiring one real-time communication, per CMS MLN MM14250.
2. ICD-10-CM FY2026 update (effective October 1, 2025). The FY2026 update revised the code set across specialties. The change that matters most for chiropractic secondary diagnoses is the deletion of M54.5 and its split into M54.50, M54.51, and M54.59. The M99.01 through M99.05 subluxation codes are unchanged, per the CMS ICD-10 FY2026.
3. Chiropractic taxonomy code for payer credentialing (111N00000X). Chiropractors credentialing with Medicare, Medicaid, and commercial payers fall under taxonomy code 111N00000X (Doctor of Chiropractic). It has to appear on every PECOS application and CAQH profile, and an incorrect entry delays credentialing. For enrollment support, MedSole's provider enrollment and credentialing services handle chiropractic credentialing at $99 per insurance.

Chiropractic Medical Billing and Credentialing at MedSole RCM: 2.99% Billing, $99 Per Payer

MedSole RCM provides full-service chiropractic medical billing at 2.99% of collections, among the most competitive published rates in the U.S. market in 2026. The service covers the chiropractic CPT codes a practice bills daily, with payer credentialing at $99 per insurance, no setup fees, and no long-term contract.

MedSole RCM bills chiropractic practices at 2.99% of collections against an industry standard of 4% to 9%, which saves a practice collecting $50,000 a month roughly $500 to $3,000 a month in billing fees. Credentialing runs $99 per payer against a typical market rate of $150 to $300. Practices that need both get them from one provider.

Chiropractic practices ready to cut denial rates and billing costs can schedule a free billing audit through MedSole's outsourced chiropractic billing services.

Practices that need chiropractic payer enrollment can start with MedSole's provider enrollment and credentialing services at $99 per insurance.

For end-to-end revenue cycle management that folds billing, credentialing, and AR recovery into one agreement, MedSole's chiropractic revenue cycle management covers all three at the 2.99% rate.

Frequently Asked Questions: Chiropractic CPT Codes 2026

What is CPT code 98941 for chiropractic?

CPT code 98941 is chiropractic manipulative treatment of the spine across three to four spinal regions. It's the most commonly billed CMT code in chiropractic practices. Medicare and most commercial payers cover 98941 when the AT modifier is appended for active treatment. The 2026 Medicare national average is near $38 per encounter, and commercial payers usually pay more.

What is CPT code 98943 for chiropractic?

CPT code 98943 is chiropractic manipulative treatment for extraspinal regions, meaning joints outside the spine: shoulders, elbows, wrists, hips, knees, ankles, ribs, and the temporomandibular joint. Medicare doesn't cover 98943. Append Modifier GY when billing it to Medicare to flag a statutorily excluded service. Billing 98943 alongside a spinal CMT code the same day needs Modifier 59 on 98943.

What is CPT code 97140 for chiropractic?

CPT code 97140 is manual therapy, including joint mobilization, myofascial release, and manual traction, billed in 15-minute units. For chiropractors, 97140 can't be billed for the same spinal region where CMT was performed the same day. Billed for a different region, it needs Modifier 59 or XS to prevent an NCCI bundling denial.

What is the difference between CPT 97110 and 97140?

CPT code 97110 has the patient actively performing exercises to build strength, endurance, or range of motion. CPT code 97140 has the provider applying hands-on techniques, including joint mobilization and myofascial release. Both are timed codes billed in 15-minute units. Billed together the same day, NCCI requires Modifier 59 and documentation of separate time intervals or distinct regions.

What is CPT code 97012 for chiropractic?

CPT code 97012 is mechanical traction, a supervised modality that applies a controlled pulling force to the spine. It's billed once per session whatever the duration, not in 15-minute units. Roller tables and intersegmental traction devices are typically reported under CPT 97039 instead. Medicare doesn't cover 97012 under the chiropractic benefit; commercial coverage varies by plan.

What is CPT code 97014 for chiropractic?

CPT code 97014 is unattended electrical stimulation, but it's invalid on the Medicare Physician Fee Schedule, so billing it to Medicare draws an automatic denial. The correct code for unattended electrical stimulation on Medicare claims is HCPCS G0283, and UnitedHealthcare also requires G0283. Commercial payers including BCBS, Aetna, and Cigna typically accept 97014; rates vary by contract.

What CPT codes can chiropractors use?

Chiropractors primarily use CPT codes 98940-98943 for spinal and extraspinal manipulation, 97110 and 97140 for therapeutic procedures, 97012 for mechanical traction, 97014 or G0283 for electrical stimulation, 97035 for ultrasound, and E/M codes 99202-99215 for evaluations. Medicare covers only 98940, 98941, and 98942, each with the AT modifier. Commercial payers may cover the rest, depending on the plan.

Can you bill 97140 and 98941 together?

Yes, CPT 97140 and 98941 can be billed the same day, but only when the manual therapy targets a different anatomical region from the spinal manipulation. The note has to specify the distinct region for each service, and Modifier 59 or XS goes on 97140. Billing both for the same region denies the 97140 line.

What is the AT modifier in chiropractic billing?

The AT modifier signals active treatment on Medicare chiropractic claims. It goes on CPT 98940, 98941, and 98942 on every Medicare claim where treatment is active and corrective rather than maintenance care. Claims submitted to Medicare without the AT modifier are denied automatically. The modifier signals the patient hasn't reached maximum therapeutic benefit and measurable improvement is expected.

Are there new CPT codes for chiropractic adjustments in 2026?

No new chiropractic manipulative treatment codes arrived in 2026. CPT 98940, 98941, 98942, and 98943 are unchanged in the AMA CPT 2026 code set. The 2026 release added 288 new codes across all specialties, concentrated in digital health and remote monitoring. New RTM codes 98985 and 98979 apply to chiropractors running remote musculoskeletal monitoring programs.

What ICD-10 codes are used for chiropractic Medicare claims?

For Medicare chiropractic claims, the primary diagnosis has to be an M99.0x subluxation code: M99.01 (cervical), M99.02 (thoracic), M99.03 (lumbar), M99.04 (sacral), or M99.05 (pelvic). Secondary diagnoses from the M54 series, M54.50 for low back pain or M54.2 for cervicalgia, support medical necessity but can't sit primary.

What is the difference between CPT 97012 and mechanical traction?

CPT code 97012 reports mechanical traction, which is true mechanical spinal traction applying a sustained or intermittent pulling force with a specialized device. Roller tables that create passive rolling movement without sustained distraction aren't mechanical traction and belong under CPT 97039 instead. Billing roller-table services under 97012 is a known audit trigger in Medicare contractor reviews.

What is CPT code 97035 for chiropractic?

CPT code 97035 is ultrasound therapy, a timed code billed in 15-minute units that requires constant attendance by the provider. The note records the frequency, intensity setting, and area treated. Medicare doesn't cover 97035 billed by chiropractors under the chiropractic benefit. Commercial payers may cover it; the 2026 rate runs roughly $24 to $27 per unit where it's payable.

What is CPT code 98940 for chiropractic?

CPT code 98940 is chiropractic manipulative treatment for one to two spinal regions. It's billed when a chiropractor adjusts one or two of the five recognized spinal regions: cervical, thoracic, lumbar, sacral, and pelvic. Medicare covers 98940 with the AT modifier for active treatment of subluxation. The note must name which regions were treated, rather than logging “lower spine.”