CPT Codes 98940, 98941, and 98942: What Chiropractors Need to Document

Key Takeaways

• CPT 98940, 98941, and 98942 are distinguished by how many spinal regions are manipulated during the visit: one or two, three or four, or all five regions.
• Region count should reflect the treatment performed on that date, not the number of diagnoses, complaints, or individual vertebral levels documented.
• Region count determines the appropriate CMT code level, but it does not by itself establish coverage or medical necessity. The documentation and diagnoses must also support the service under the applicable payer’s rules.
• The current note should make the treated regions easy to trace from the findings and assessment through the manipulation performed.
• Medicare adds separate coverage and documentation requirements, including use of the AT modifier for qualifying active/corrective treatment rather than maintenance care.
• Before billing, confirm that the note, code selection, diagnosis support, modifiers, and applicable payer requirements are consistent.

Choosing between CPT 98940, 98941, and 98942 starts with one question: How many spinal regions were manipulated during this visit?

In general, 98940 corresponds to one or two spinal regions, 98941 to three or four, and 98942 to all five. The selection follows the regions treated that day, not the number of diagnoses listed or individual vertebral levels addressed.

Region count determines which level within the spinal CMT code family describes the service performed. It does not, by itself, establish that the service meets a payer’s coverage or medical-necessity requirements. The current documentation and diagnosis coding should also support why the treated regions were part of the service billed.

This guide explains how region count drives code selection and what the current note should make clear. Always verify the current CPT code set and payer-specific requirements before billing.

What Is the Difference Between CPT 98940, 98941, and 98942?

CPT 98940 is the spinal CMT code associated with manipulation of one or two spinal regions, while CPT 98941 applies to three or four regions and CPT 98942 to all five. The practical difference among these three code levels is the number of spinal regions treated.

• 98940: Manipulation of one or two spinal regions.
• 98941: Manipulation of three or four spinal regions.
• 98942: Manipulation of all five spinal regions.

Start with the treatment performed and select the code that matches it rather than working backward from a code to the documentation.

For example, if the cervical and thoracic regions were manipulated, the region count is two. A lumbar diagnosis elsewhere in the chart does not make the service a three-region manipulation unless the lumbar region was also treated.

The reverse is also important. Documenting that three regions were manipulated may establish the region count for 98941, but the claim still needs appropriate clinical and diagnosis support under the applicable payer’s rules.

A higher region count does not indicate better care or a more valuable visit. It describes a different scope of spinal treatment.

CPT 98943 addresses manipulation outside the spinal regions and should be evaluated separately under the current code set and applicable payer rules.

CPT 98940, 98941, and 98942 at a Glance

This table summarizes code-selection logic and does not reproduce official CPT descriptors. Verify the current CPT code set, payer-specific requirements, and applicable Medicare guidance before billing.

What Counts as a Spinal Region for 98940–98942?

The five spinal regions used when selecting among 98940, 98941, and 98942 are cervical, thoracic, lumbar, sacral, and pelvic.

Count regions, not individual vertebrae. Treating several levels within the cervical spine still represents one cervical region when choosing among 98940, 98941, and 98942.

Diagnosis coding and treatment-region count answer different questions. Diagnoses help describe and support the patient’s condition; 98940, 98941, and 98942 describe how many spinal regions were manipulated that day.

Keep those decisions separate while applying any additional payer-specific diagnosis and medical-necessity requirements. A diagnosis in a region that was not manipulated does not increase the CMT region count, and a treated region does not automatically satisfy a payer’s diagnosis or coverage requirements simply because it was listed in the treatment portion of the note.

What Should the Note Document to Support 98940, 98941, or 98942?

The note should allow another qualified reader to understand why the patient was treated, what the clinician found, and which spinal regions were manipulated.

The most important word is current.

The current visit should be easy to reconstruct without searching previous notes, old template fields, or unrelated diagnoses for evidence of what happened that day.

For a typical visit, the record may include:

• The current complaint or functional problem, when relevant.
• Relevant examination or assessment findings.
• The spinal regions involved and manipulation performed.
• The assessment or diagnosis supporting the service under applicable payer rules.
• Response, progress, and the current plan when appropriate.

The goal is traceability. The reader should be able to follow the current problem and clinically relevant findings into the assessment and then identify the treatment that was actually performed.

A long template is not more useful if it contains findings from previous visits or lists every possible spinal region without making today’s treatment clear. A concise note that supports the current treatment scope is easier to follow than a lengthy record that forces someone to reconstruct the visit.

Initial visits, re-examinations, and routine follow-ups may also require different levels of documentation. Medicare has separate expectations for initial and subsequent encounters, and commercial payer requirements can differ as well. Practices should verify current guidance rather than applying one documentation template to every visit type.

Does the Note Support the CMT Code?

Before billing, ask:

• Is the current complaint or functional problem clear where required?
• Are relevant findings documented for this visit?
• Are the treated spinal regions identifiable?
• Does the assessment or diagnosis support the service under applicable payer rules?
• Is the manipulation performed clear?
• Does the documented treatment scope match the region count associated with 98940, 98941, or 98942?
• Where the payer requires region- or level-specific clinical support, does the documentation provide it?

Use this as a traceability check, not as a substitute for payer-specific documentation requirements.

What Changes When Billing Medicare?

Medicare does not change the basic region-count logic for 98940, 98941, and 98942, but it adds separate coverage, medical-necessity, diagnosis, documentation, and modifier requirements.

Under Medicare Part B, the chiropractic benefit is limited to manual manipulation of the spine to correct a qualifying subluxation. Other diagnostic or therapeutic services furnished by a chiropractor are outside Medicare’s covered chiropractic benefit and should not be treated as covered simply because they are part of the patient’s chiropractic care.

That distinction matters because selecting the correct region-count code is only one part of a Medicare claim. The record must also support the cited subluxation, the patient’s condition, the treatment provided, and the medical necessity of continued care. CMS guidance also expects the patient’s symptoms to relate to the cited subluxation level, while applicable Medicare Administrative Contractor guidance may add specific diagnosis and claim-reporting requirements.

For qualifying active/corrective treatment, the AT modifier is used with 98940, 98941, or 98942. The AT modifier should not be appended when the service represents maintenance therapy. Once the patient’s condition has stabilized and further objective clinical improvement is not expected, Medicare considers additional manipulative treatment maintenance therapy rather than covered active treatment.

The modifier also does not establish medical necessity by itself. The documentation still needs to support the patient’s condition, treatment status, and care provided.

Additional Medicare modifiers may apply when a service is expected to be denied. For example, current Medicare billing guidance identifies GA and GZ for certain anticipated medical-necessity denials depending on whether the appropriate beneficiary notice requirements have been met. Those rules affect beneficiary liability and should be applied based on the specific situation rather than automatically added to every chiropractic claim.

Medicare-Specific Check

• Confirm that the service falls within Medicare’s covered chiropractic benefit.
• Confirm that the documentation supports the cited subluxation, the patient’s condition, and the treatment performed.
• Use the AT modifier when applicable to qualifying active/corrective treatment.
• Do not use AT to characterize maintenance care.
• Do not rely on AT alone to establish medical necessity.
• Check whether additional modifiers or beneficiary-notice requirements apply when denial is expected.
• Verify current CMS guidance and applicable Medicare Administrative Contractor instructions before billing.

Common Coding and Documentation Mismatches

Most problems with 98940, 98941, and 98942 are not caused by complicated region-count logic. They occur when the code, current note, diagnoses, treatment performed, and payer requirements do not line up cleanly.

The Code Reflects More Regions Than the Note Supports

If 98941 is billed, the current record should make treatment across three or four spinal regions reasonably clear.

If only cervical and thoracic treatment can be identified, staff should not have to search old documentation, template fields, or unrelated diagnoses to find a third region.

The same principle applies to 98942. Treatment across all five regions should be supported by the current encounter rather than inferred from boilerplate.

Remember that showing the correct number of treated regions addresses the CMT code level. It does not eliminate separate diagnosis, coverage, or medical-necessity requirements imposed by the payer.

Diagnosis Count Is Mistaken for Treatment-Region Count

Multiple diagnoses do not automatically mean multiple manipulated regions.

Diagnosis coding helps describe and support the patient’s condition, while 98940, 98941, and 98942 reflect the number of spinal regions manipulated. Apply payer-specific diagnosis requirements separately.

For example, three diagnoses do not justify 98941 if only two spinal regions were manipulated. Likewise, manipulating three regions does not make every 98941 claim payable if the documentation or diagnoses fail to support the service under the payer’s rules.

Carried-Forward Documentation Obscures the Current Visit

Copied-forward documentation becomes a problem when today’s care is difficult to distinguish from prior care.

A template may still contain cervical, thoracic, lumbar, sacral, and pelvic findings from an earlier visit. That does not establish that all five regions were assessed or treated today.

Review carried-forward content before signing the note. The issue is not whether the note is long enough. The issue is whether it accurately represents the current encounter.

Medicare Active Treatment and Maintenance Care Are Blurred

For Medicare claims, the documentation and claim should describe the same stage of care.

If the record reads like maintenance care while the claim uses the AT modifier for active/corrective treatment, review the inconsistency before billing. CMS states that AT should not be appended to maintenance therapy and that the modifier itself does not prove medical necessity.

For more examples of disconnects between clinical documentation and claims, see ChiroTouch’s 9 Chiropractic Coding & Billing Red Flags to Avoid.

Final Check Before Billing 98940, 98941, or 98942

Before submitting the claim, make the coding decision one final time from the current note:

1. How many spinal regions were manipulated today?
2. Can those regions be identified in the current documentation?
3. Does the clinical record support why those regions were part of the service?
4. Do the diagnosis and documentation meet the applicable payer’s requirements?
5. Have any required modifiers been checked for this payer and treatment category?
6. If Medicare applies, is the treatment active/corrective rather than maintenance, and have any applicable beneficiary-notice or denial modifiers been addressed?
7. Has copied-forward content been reviewed so the note reflects this date of service?

This final check helps prevent the clinical and billing workflows from drifting apart. When the treatment performed is clear in the current note, billing staff spend less time reconstructing the visit after the fact.

When documentation and billing workflows stay connected, the service recorded during the encounter is easier for billing teams to trace downstream. ChiroTouch is designed to help chiropractic practices keep clinical documentation and billing workflows together in one practice management system.