According to the American Chiropractic Association, more than 35 million Americans receive chiropractic care each year. Accurate billing is the only way to keep payments steady and avoid denials. The process starts with using the right Chiropractic CPT codes, but it does not end there. Medicare rules, documentation requirements, and the correct use of forms and modifiers all play a role in whether a claim gets paid or denied. Many providers struggle because these rules can feel restrictive and easy to overlook. This guide explains the key chiropractic CPT codes, Medicare rules, documentation needs, and ABN use.
Chiropractic services are billed using a defined set of CPT codes. Correct code selection is critical for reimbursement and compliance. Providers should understand which codes apply to spinal adjustments, extraspinal manipulations, examinations, and adjunct therapies.
The table below consolidates the most common CPT codes used in chiropractic billing:
| Code | Category | Description | Details |
|---|---|---|---|
| 98940 | CMT | Chiropractic manipulative treatment, spinal | 1–2 regions |
| 98941 | CMT | Chiropractic manipulative treatment, spinal | 3–4 regions |
| 98942 | CMT | Chiropractic manipulative treatment, spinal | 5 regions |
| 98943 | CMT | Chiropractic manipulative treatment, extraspinal | 1 or more regions outside the spine (e.g., shoulders, knees) |
| 99202–99205 | E/M | New patient office/outpatient visits | Levels 2–5, complexity increases with level |
| 99212–99215 | E/M | Established patient office/outpatient visits | Levels 2–5, complexity increases with level |
| 97110 | Therapy | Therapeutic exercises | Per 15 minutes |
| 97140 | Therapy | Manual therapy techniques | Per 15 minutes, distinct from CMT |
| 97012 | Therapy | Mechanical traction | Single service |
| 97014 / G0283 | Therapy | Electrical stimulation | 97014 (general), G0283 (Medicare use) |
| 97530 | Therapy | Therapeutic activities | Per 15 minutes |
| 97535 | Therapy | Self-care/home management training | Per 15 minutes |
Medicare rules for chiropractic care are very strict. It only pays for a small part of what chiropractors usually do.
Medicare will only cover chiropractic care if it’s for “manual manipulation of the spine to correct a vertebral subluxation,” which means fixing a misalignment in the spine. Medicare doesn’t pay for other chiropractic services like X-rays, massage, or acupuncture. The coverage is for active treatment of acute or chronic conditions, but not for routine or ongoing maintenance care. You’ll need to pay your Part B deductible and coinsurance, which is usually 20% of the approved cost for covered services.
For subluxation, Medicare does not pay for the device itself; it only covers the adjustment.
Medicare does not pay for other common chiropractic services. These include:
If an MD or DO orders imaging, Medicare may cover it. But if the chiropractor orders it, Medicare will not.
Also, 98943 (extraspinal manipulation) is not part of Medicare’s chiropractic benefit.
Medicare will only pay for chiropractic care if the records prove medical necessity. That means you need to show both the subluxation and the patient’s active care needs. Each note must show why the selected chiropractic CPT codes were billed and how the care met Medicare’s definition of medical necessity.
You can document a subluxation in two ways:
One of the two must be either Asymmetry (A) or Range of motion (R).
The first visit has to cover the basics:
For every visit after the first, your notes should include:
Medicare only pays for active treatment, where the goal is to improve function or reduce symptoms. Once care shifts to maintenance, focusing on preventing symptoms from returning, it is no longer covered.
An Advance Beneficiary Notice (ABN, form CMS-R-131) is one of the most important tools for chiropractors working with Medicare patients. It protects both you and the patient when services are likely to be denied.
When care is no longer medically necessary, like maintenance spinal manipulation, Medicare will not pay. A signed ABN is required before you continue. Without it, you usually cannot bill the patient, and you’ll be stuck with the cost.
An ABN can cover a defined course of care for up to one year if you clearly note the frequency and duration. If treatment changes or extends beyond that, you need to issue a new ABN.
Timing matters. You cannot give an ABN after care has already been provided. If you do, those earlier services remain the provider’s responsibility.
Modifiers help Medicare understand the circumstances of a service. They can shift liability, explain why something was billed, or confirm active treatment. Using them correctly is key to compliance.
| Modifier | When to Use It | Who Pays | Example |
|---|---|---|---|
| AT | Active/corrective spinal manipulation (98940–98942) | Medicare (if medically necessary) | 98941-AT |
| GA | ABN signed; you expect a denial for lack of necessity | Patient | 98941-GA (maintenance CMT with ABN) |
| GZ | No ABN; you expect denial | Provider | 98941-GZ (maintenance with no ABN) |
| GY | Service is statutorily non-covered (never a Medicare benefit) | Patient | 98943-GY (extraspinal manipulation, exams) |
| GX | Voluntary ABN for non-covered services | Patient | Exam with GX + GY |
| 59 | Distinct procedural service; rarely applies in chiropractic | Medicare if the criteria are met | Used only if multiple procedures are required, but not common |
| 25 | Significant, separate E/M service on the same day | Not payable to chiropractors under Medicare, but may appear with other provider types | N/A |
Medicare does not set a hard cap on the number of chiropractic visits, but every claim must be backed by medical necessity and documented improvement. High use patterns can trigger review by your Medicare Administrative Contractor (MAC). Only one chiropractic manipulation is payable per patient per day, and services like room or ward fees are not covered.
For treatment length, acute cases are usually expected to last a few weeks to about three months, with visit frequency tapering as the patient improves. Chronic conditions may justify longer care, but not at the same frequency as acute care; progress must still be measured and recorded.
Coding is also tightly defined. Covered services are limited to CPT codes chiropractic 98940 (1–2 regions), 98941 (3–4 regions), and 98942 (5 regions). For diagnosis, the primary ICD-10 code must be M99.0x, indicating segmental or somatic dysfunction in the region treated. Secondary neuromusculoskeletal diagnoses, such as low back pain or radiculopathy, may be added when supported by policy and clinical findings.
Medicare chiropractic billing is strict, but it becomes manageable when you follow the rules and use the right tools. If it still feels overwhelming, you don’t have to handle it alone.
Medical chiropractic billing companies like MedCare MSO can help you apply chiropractic CPT codes correctly. They will handle the paperwork, reduce denials, and keep revenue steady. That frees you to focus on your patients.
By outsourcing your billing services to us, you can expect revenue growth of up to 20%
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