Chiropractic CPT codes & modifiers
Chiropractic CPT Codes & Modifiers Cheat Sheet (2026)
The codes you bill every day (CMT, therapies, E/M) with the modifiers and diagnoses that decide whether they pay. A clean, current reference for the front office.
How to use
The codes a chiropractic office actually bills — in one place, kept current.
Most chiropractic claims are built from a small, predictable set of CPT codes: the spinal adjustment, a handful of therapies and modalities, the occasional evaluation, and the modifiers and ICD-10 diagnoses that tie them together. Get that core set right and the vast majority of your claims pay on the first pass. Get a modifier or a diagnosis pointer wrong and the same claim bounces back with a denial code that tells you exactly what failed, if you know how to read it.
This is the reference our coordinators work from, condensed for the front office. It covers the CMT codes, the time-based therapies and supervised modalities, new-versus-established E/M, the four modifiers that matter most, and the common ICD-10 families, plus two edits that quietly cost practices money. For the Medicare-specific rules behind these codes, see our chiropractic Medicare billing guide; for what to do when a claim is denied, the full billing service walks through how each denial gets worked.
A general reference, not coding advice. Code descriptors, coverage policies, and payer edits change, and the right code always depends on what the documentation supports for a specific patient. Use this sheet to orient, then verify against current CPT, ICD-10, and your payer’s policy before you bill. Nothing here is legal, compliance, or coding advice for a particular claim.
CMT codes
Chiropractic manipulative treatment (CMT): 98940 to 98943.
The adjustment is the heart of the claim. The spinal CMT code you choose is driven entirely by the number of spinal regions treated. Cervical, thoracic, lumbar, sacral, and pelvic are the five spinal regions for counting purposes. The extraspinal code stands apart, and one critical difference decides who pays: Medicare covers the three spinal codes and never the extraspinal one.
Count regions, not segments
The CMT code reflects how many of the five spinal regions were manipulated, not how many individual segments. Adjusting three vertebrae all within the lumbar spine is still one region. The documentation has to support each region you count toward 98941 or 98942.
98943 is patient-pay under Medicare
Extraspinal manipulation (98943) is statutorily excluded from the Medicare chiropractic benefit. It can be billed to the patient, and because it’s never a benefit, a voluntary ABN (CMS-R-131) is recommended so the patient knows Medicare won’t pay. Commercial, MVA, and Workers’ Comp payers may cover it; check the plan.
Therapies & modalities
Physical-medicine codes: 97110, 97112, 97140, 97012.
Beyond the adjustment, most practices bill a short list of physical-medicine codes. The distinction that drives billing is timed versus supervised: timed codes are reported in 15-minute units under the 8-minute rule, while a supervised modality is reported once per session regardless of time. Choosing the right one, and documenting the minutes, is where therapy revenue is won or lost.
Timed codes need minutes
For timed codes (97110, 97112, 97140), one unit requires at least 8 minutes of direct one-on-one time; the chart has to show the minutes. No documented time, no unit. An untimed estimate is a common audit finding.
Capacity vs. control
97110 builds what the body can do: strength, endurance, range of motion. 97112 retrains how it moves: balance, coordination, proprioception. The note must describe the activity, not just the code.
97012 is per session
97012 mechanical traction is a supervised modality, billed once per visit, not in 15-minute units. Don’t confuse it with manual traction, which falls under timed manual therapy (97140).
Evaluation & management
New vs. established, and why the CMT already includes a quick assessment.
Office E/M splits into new-patient codes (99202 to 99205) and established-patient codes (99212 to 99215), with the level set by medical decision-making or total time. A patient is “new” only if they haven’t been seen by the practice in three years; everyone else is established. New-patient levels generally reimburse higher because they carry the full history and workup.
The catch specific to chiropractic: a brief pre-adjustment assessment is considered part of the CMT itself. Billing a separate E/M on the same day requires a significant, separately identifiable service, and that’s exactly what modifier 25 is for. Routine re-checks at each visit are not separately billable; a true re-evaluation or a new complaint may be.
E/M by time
Pick the E/M level by total time, no decision-making calculus required.
Since 2021 you can choose the office E/M level two ways: by medical decision-making (MDM) or by total time on the date of the encounter. For most chiropractors, time is the simpler, safer path: there’s no MDM level to defend. Add up everything you personally spend on that patient that calendar day (reviewing records, history and exam, counseling, coordinating care, and writing your note) and record the total minutes. The time alone sets the code.
Hit the bottom of a range and you’ve earned that level, so the note just has to state the minutes. 99211 is a minimal, often nurse-only visit with no time threshold. And on a day you also adjust, a separately billable E/M still needs modifier 25.
Modifiers
Modifiers: AT, GA, 25, 59/XS.
A modifier is a two-character note to the payer that changes how a code is read. Four of them carry most of the weight on chiropractic claims, and missing or misusing any one is among the most common reasons a clean-looking claim gets denied.
Required on Medicare CMT (98940 to 98942) for active care. Without it, Medicare reads the visit as maintenance and denies it CO-50. Never apply it to a genuine maintenance visit.
Signals a signed Advance Beneficiary Notice is on file for a service Medicare is expected to deny, e.g. maintenance CMT. It shifts liability to the patient so you can bill them when the denial lands.
Appended to the E/M when a significant, separately identifiable evaluation is performed on the same day as the CMT. Without it, the E/M bundles into the adjustment and isn’t paid.
Marks a service performed in a separate region/session from a bundled procedure. The classic case is therapy in a different spinal region than the CMT. XS is the more specific “separate structure” subset of 59.
Modifiers are not a trick to force payment. Each one is an attestation that has to be true in the chart. Applied honestly, they get correct claims paid; applied loosely, they invite recoupment and audit. The distinction lives in the documentation, which is exactly what our scrubbing review checks before a claim goes out.
Diagnoses
Common ICD-10: M99.0x and M54.x.
The CPT code says what you did; the ICD-10 codes say why it was necessary, and on a CMT claim, the order matters. The subluxation drives the adjustment, so it leads; the pain or neuromusculoskeletal complaint supports medical necessity in the second position. Get the order or the region wrong and the claim returns CO-11, diagnosis inconsistent with the procedure.
On Medicare CMT, the M99.0x subluxation is primary and matched to the region treated; the M54.x pain code is the supporting secondary. Bare M54.5 is no longer billable: it was subdivided into M54.50/.51/.59, so code to the highest specificity your documentation supports.
Bundling edits
The 97140-plus-CMT edit, and Medicare coverage.
Two rules account for a large share of avoidable therapy and CMT denials. Neither is obscure, but both are easy to miss in a busy office, and a template that ignores them repeats the same loss on every claim.
97140 in the same region as the CMT
Under National Correct Coding Initiative edits, manual therapy (97140) and neuromuscular re-education (97112) bundle into the chiropractic adjustment when performed in the same spinal region. Billed together same-region, only the CMT is paid.
When the therapy is genuinely performed in a different region than the CMT and the documentation supports it, you may report both by appending modifier 59 (or XS). Same region, no modifier rescues it, and you generally can’t balance-bill the patient for the bundled line either.
Medicare pays for the spine, and only the spine
For a doctor of chiropractic, Medicare Part B covers only spinal CMT (98940 to 98942) with the AT modifier and a substantiated subluxation. It does not pay the exam, X-rays, therapies, or 98943; those are statutorily excluded from the chiropractic benefit.
Bill the excluded services elsewhere: to the patient with an ABN, or to commercial, MVA, and Workers’ Comp plans that do cover therapy and extraspinal care. Knowing which payer pays for which code is half of clean chiropractic billing.
Why the order of the columns matters: a generalist biller working from a flat template often bills 97140 alongside same-region CMT without a thought, or sends 98943 and a therapy line straight to Medicare. Both come back denied. A chiropractic-specific scrub catches them before submission, which is the difference between a clean claim and a write-off, and a big part of why practices weigh in-house billing against an outsourced chiropractic team.
Denial codes
When a claim bounces, the code tells you what to fix.
A denial code is a diagnosis for the claim. Most chiropractic rejections trace back to a handful of them, and each points straight at a field on the cheat sheet above.
None of these are mysteries once you can read them. The MVA and Workers’ Comp claims add their own filing and authorization quirks on top, another place a dedicated coordinator who knows the payers recovers money a rotating call center never touches.
Our scrub checks
We run every one of these checks before the claim goes out.
Knowing the codes is one thing; applying them correctly on every claim, every day, is another. Each row of this cheat sheet is a pre-submission scrub check our coordinators run: the AT modifier on active-care CMT, the region count behind 98941, the 8-minute rule on timed therapy, the 97140 same-region edit, the subluxation-first diagnosis order. Catching them up front is why claims pay the first time instead of bouncing back weeks later.
And it’s consultative, not just defensive. The same review catches the money generalists leave behind (undercharged E/M levels, therapy codes left off the claim, CMT lines priced below your fee schedule) and it’s a fixed, predictable cost of chiropractic billing, not a line that grows with your headcount. Many of our clients run multi-specialty centers, so the same coordinator bills the chiropractic, physical-therapy, massage, acupuncture, and nurse-practitioner visits under one roof, with the right code and payer applied to each. It’s all one flat fee: 7% of net collections, or a $1,500/month minimum, all-inclusive and month-to-month, laid out on our pricing page.
Proof
The coding expertise shows up in the collections.
“In practice over 30 years, I have never found a more professional, knowledgeable company. I have a dedicated person accessible at all times, and they’re compatible with my EHR so I have no extra steps.”
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FAQ
Chiropractic coding questions, answered.
All three are spinal chiropractic manipulative treatment (CMT); the code is set by how many of the five spinal regions you treated. 98940 covers 1 to 2 regions, 98941 covers 3 to 4, and 98942 covers all 5. You count regions (cervical, thoracic, lumbar, sacral, pelvic), not individual segments. Extraspinal manipulation is a separate code, 98943, which Medicare does not cover.
Sometimes; it depends on the region. Under NCCI edits, manual therapy (97140) bundles into the CMT when both are performed in the same spinal region, and only the CMT is paid. If the 97140 is performed in a different region than the adjustment and the documentation supports it, you can report both by appending modifier 59 (or XS) to indicate a distinct service. Billing them together in the same region without justification leads to a denial.
Append AT (Active/Corrective Treatment) to Medicare spinal CMT (98940 to 98942) whenever the care is active and meant to improve the patient’s condition. Without it, Medicare treats the visit as maintenance and denies it as not medically necessary (CO-50). It should only be used when the documentation genuinely supports active care. Applying it to a maintenance visit is a compliance violation. See our Medicare billing guide for the full rule set.
Only when the E/M is a significant, separately identifiable service beyond the brief assessment already built into the CMT, for example a new complaint or a true re-evaluation. In that case, append modifier 25 to the E/M code. A routine pre-adjustment check at each visit is part of the CMT and isn’t separately billable. Documentation has to clearly support the separate service.
For CMT, the subluxation is primary, coded in the M99.0x family (segmental and somatic dysfunction) and matched to the spinal region treated. The pain or neuromusculoskeletal complaint, such as an M54.x dorsalgia code, is the supporting secondary diagnosis and can’t stand alone as primary for CMT. If the primary diagnosis, the region, and the diagnosis pointers disagree, the claim returns CO-11.
No. This is a general educational reference, not coding, legal, or compliance advice for any specific claim. Code descriptors, ICD-10 details, Medicare coverage, and payer edits change over time, and the correct code always depends on what a patient’s documentation supports. Verify against current CPT, ICD-10, and your payer’s policy before billing, or let our coordinators handle the coding and scrubbing for you.
Official sources
Where these rules come from
The codes, modifiers, and bundling edits on this page come from these primary AMA and CMS sources. CPT descriptors and NCCI edits change quarterly, so verify the current code and edit before billing.
- AMA: CPT (Current Procedural Terminology)
- CMS: National Correct Coding Initiative (NCCI) PTP edits
- CMS: National Correct Coding Initiative (NCCI)
- CMS: Billing & Coding: Chiropractic Services (A56273)
Billing rules also vary by state. See our state-by-state chiropractic billing guides. Each covers the local auto-injury, Workers’ Comp and Medicaid rules, cited to the governing statute.
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