Accurate chiropractic coding starts with one simple rule: the code must match the service performed and the documentation supporting it. For 2025–2026, practices also need to distinguish between CPT updates, ICD-10-CM fiscal-year changes, and payer-specific billing rules.
This chiropractic billing codes cheat sheet focuses on the codes chiropractors, billers, and practice managers encounter most often, with particular attention to Medicare requirements. It is designed as a practical reference, not a replacement for the current CPT codebook, ICD-10-CM guidelines, or individual payer policies.
Chiropractic CPT Codes: 98940, 98941, 98942
The primary chiropractic manipulation CPT codes are 98940, 98941, and 98942, based on the number of spinal regions treated. 98943 describes extraspinal manipulation but is not covered under Medicare’s chiropractic benefit. For applicable Medicare claims, 98940–98942 require the AT modifier when active/corrective treatment is provided, and the documentation must support the diagnosis, spinal level, medical necessity, and service reported.
| CPT Code | Description |
|---|---|
| 98940 | CMT, spinal, 1–2 regions |
| 98941 | CMT, spinal, 3–4 regions |
| 98942 | CMT, spinal, 5 regions |
| 98943 | CMT, extraspinal, 1 or more regions |
Codes 98940–98942 are not reported as add-on codes for individual regions. For example, when five spinal regions are manipulated, 98942 is reported rather than combining multiple CMT codes. CMS coding guidance also states that 98940–98942 require the AT modifier for applicable Medicare active/corrective treatment.
Important: CPT availability does not automatically mean Medicare coverage. CMS’s chiropractic benefit is limited to manual manipulation of the spine for a covered spinal subluxation; extraspinal manipulation is not part of that Medicare chiropractic benefit.
Accurate CPT and ICD-10-CM selection is essential for clean claims and proper reimbursement. Professional medical coding services can help chiropractic practices review documentation, apply appropriate diagnosis and procedure codes, and identify coding issues before claims are submitted.
Chiropractic ICD-10-CM Codes
For Medicare chiropractic claims, commonly referenced ICD-10-CM codes include:
| ICD-10-CM | Description |
|---|---|
| M99.01 | Segmental and somatic dysfunction of cervical region |
| M99.02 | Segmental and somatic dysfunction of thoracic region |
| M99.03 | Segmental and somatic dysfunction of lumbar region |
| M99.04 | Segmental and somatic dysfunction of sacral region |
| M99.05 | Segmental and somatic dysfunction of pelvic region |
| M99.11 | Subluxation complex, cervical region |
| M99.12 | Subluxation complex, thoracic region |
| M99.13 | Subluxation complex, lumbar region |
| M99.14 | Subluxation complex, sacral region |
| M99.15 | Subluxation complex, pelvic region |
CMS emphasizes that selecting an ICD-10-CM code alone does not guarantee coverage. The service must still meet the applicable medical-necessity requirements.
2025 vs. 2026 ICD-10-CM: Know the Date of Service
One common billing mistake is treating “2026 ICD-10” as one code set covering the entire calendar year. ICD-10-CM follows a fiscal-year cycle. CDC guidance shows that FY2025 applies through September 30, 2025, while the FY2026 release applies from October 1, 2025 through September 30, 2026. CDC also released an April 1, 2026 update for the remainder of FY2026.
For billing teams, the practical rule is: Always select the ICD-10-CM version applicable to the patient’s date of service. This becomes particularly important when a claim is corrected months after the original encounter.
Do Not Use the Outdated M54.5 Code
Older chiropractic billing articles frequently list M54.5 – Low back pain. That code is obsolete. CMS documents that M54.5 was deleted effective October 1, 2021, with more specific replacement codes introduced, including M54.50, M54.51, and M54.59. For current claims, practices must select the appropriate active ICD-10-CM code based on the provider’s actual documentation.
Medicare AT Modifier
For Medicare claims involving 98940, 98941, or 98942, modifier AT is used for active/corrective treatment.
CMS specifies that:
- AT should be reported when active/corrective treatment is provided.
- AT should not be appended for maintenance therapy.
- The presence of AT alone does not establish medical necessity.
CMS also distinguishes acute or chronic active treatment from maintenance care and expects the documentation to support that distinction.
AT Modifier Quick Check
Before submitting a Medicare CMT claim, confirm:
- 98940, 98941, or 98942 is the correct CMT code.
- The treatment is active/corrective.
- The documentation supports the spinal condition.
- The appropriate ICD-10-CM code is reported.
- The AT modifier is used when required.
Other Codes Chiropractors May Encounter
Depending on payer coverage and scope of services, chiropractic practices may also encounter codes associated with therapeutic procedures and modalities, such as:
| CPT/HCPCS | General Description |
|---|---|
| 97012 | Mechanical traction |
| 97110 | Therapeutic exercises |
| 97140 | Manual therapy |
| 97035 | Ultrasound therapy |
| G0283 | Unattended electrical stimulation for applicable Medicare reporting |
These services should not be assumed to be covered under Medicare’s chiropractic benefit simply because a valid CPT or HCPCS code exists. Commercial and Medicaid coverage can differ substantially, so the payer’s policy should be checked before billing. CMS specifically states that Medicare chiropractic coverage excludes services other than manual manipulation for treatment of spinal subluxation.
Beyond code selection, practices must also manage claim submission, payer rules, denials, and A/R follow-up. Chiropractic billing services can help coordinate these billing functions while keeping coding and documentation requirements aligned.
Chiropractic Billing Documentation Checklist
Correct codes cannot compensate for incomplete documentation.
For chiropractic claims, the record should support:
- Date of initial treatment or exacerbation
- Precise spinal region and level of subluxation
- Diagnosis supporting the service
- CPT code corresponding to the service performed
- Treatment classification: acute, chronic, or maintenance
- Treatment response/progress
- Provider signature/authentication
- X-ray date when applicable
CMS specifically identifies the initial treatment/exacerbation date, precise spinal location and level, X-ray date when applicable, ICD-10-CM level, and treatment classification in its chiropractic billing guidance.
Final Chiropractic Billing Codes Cheat Sheet
For 2025–2026, keep these rules at the center of your billing workflow:
98940 = 1–2 spinal regions
98941 = 3–4 spinal regions
98942 = 5 spinal regions
98943 = extraspinal manipulation
M99.01–M99.05 = regional segmental and somatic dysfunction codes commonly referenced in Medicare chiropractic billing.
AT modifier = active/corrective Medicare chiropractic treatment for applicable CMT codes.
M54.5 = deleted and should not be used for current claims.
ICD-10-CM = select the code set applicable to the date of service, not simply the calendar year.
Most importantly, never choose a chiropractic code solely because it appears on a cheat sheet. Confirm that the code reflects the service actually performed, is supported by the clinical record, and is payable under the patient’s specific payer policy.
For chiropractic practices, accurate coding is the connection between clinical documentation and reimbursement. A current CPT and ICD-10-CM workflow can help reduce avoidable claim errors, but payer-specific coverage and Medicare requirements must always be checked before submission.
CodeCure recommends using the current AMA CPT resources, CDC/NCHS ICD-10-CM materials, CMS guidance, and the applicable Medicare Administrative Contractor or payer policy when making final coding and billing decisions.
