Chiropractic manipulative treatment of all five spinal regions in one visit: cervical, thoracic, lumbar, sacral, and pelvic.
- Medicare
- $49.77
- Work RVU
- 0.94
- Global, days
- 0
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Level of subluxation for each spinal region treated, tied to the matching M99.0x diagnosis
- PART findings: pain, asymmetry or misalignment, range of motion change, and tissue or tone change
- Treatment plan with goals, frequency, and expected duration
- Progress toward goals at each visit, showing the care is active and not maintenance
- Regions actually adjusted that day, which drive the code level
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
98942 is the highest spinal chiropractic code and requires manipulation of all five spinal regions in the same visit. Very few patients need all five every time, so payers flag providers who bill it routinely.
For Medicare, each of the five regions needs a documented subluxation, its own M99.0x code, and findings that support treating it that day. The AT modifier is required for active care. A note that lists five regions without region-specific findings will be downcoded on review.
Extraspinal adjustments (shoulder, knee, ankle, wrist, TMJ, ribs) do not count toward the five. Those go to 98943, which Medicare does not cover but many commercial plans do.
In an ortho group, 98942 often follows a car accident or a fall where the patient has complaints from the neck down through the pelvis. Even then, by the third or fourth visit some regions should be improving and dropping off. A plan that never changes reads as maintenance care, and Medicare will deny it.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (0.94) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (1.49) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.94 |
| Practice expense RVU | 0.54 |
| Malpractice RVU | 0.01 |
| Total RVU | 1.49 |
| Medicare national rate | $49.77 |
| Global period | 0 days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $49.77 |
HOPD (APC 5811) Hospital outpatient department | $22.06 |
Common denial reasons
The recurring reasons claims for CPT 98942 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing AT modifier on Medicare claims for active corrective treatment
- Primary diagnosis is not a subluxation code (M99.0x) when Medicare requires it
- Notes read as maintenance care with no functional improvement
- Region count does not support the code billed
- Commercial plan visit limit for chiropractic exhausted
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01What is CPT 98942?
02Do extremity adjustments count toward 98942?
03Is 98942 audited often?
04Does Medicare pay for 98942?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe records the findings for each spinal region adjusted and the patient's progress against the plan, which is what reviewers look for on 5 region claims.
See how Mira captures CPT 98942 documentation