Medicare chiropractor cost per visit: what 98940, 98941 and 98942 pay in 2026

One covered service, priced by the number of spinal regions

Section 240 of the Medicare Benefit Policy Manual, chapter 15, sets the boundary in its first sentence. The term "physician" under Part B includes a qualifying chiropractor, but only for treatment by means of manual manipulation of the spine to correct a subluxation. Section 240.1.1 then narrows "manual" to treatment by use of the hands, and allows hand-held devices whose thrust is controlled manually. Medicare.gov describes the same thing for patients: Part B covers adjustments of the spine when the chiropractor uses their hands or a device called an "activator."

That covered service is billed with one of three CPT codes, and the code is chosen by how many spinal regions are manipulated at the visit, not by how long the visit lasts. 98940 is chiropractic manipulative treatment of one to two spinal regions; 98941 covers three to four regions; 98942 covers five regions. The CPT code set divides the spine into its regions, and the manual's own location table in section 240.1.4 lists the areas a subluxation can be recorded in: the neck (occiput and cervical vertebrae), the back (thoracic vertebrae and the rib joints), the low back (lumbar vertebrae), the pelvis and the sacrum. A visit is billed with one of the three codes, so one visit produces one manipulation line.

Two limits in the manual reach the bill directly. The first is in section 240.1.1, which says twice that no additional payment is available for use of a hand-held device, and that Medicare does not recognize an extra charge for the device itself. A line for an adjusting instrument on a Medicare claim has no fee schedule amount behind it. The second is in section 240.1.5: describing practices that gave four or five treatments a day and charged "room or ward fees," the manual says those fees are not covered and that Medicare reimbursement is limited to not more than one treatment per day.

So the most a Medicare chiropractic claim can contain, as far as covered services go, is one of three codes on one date. Every other line on a chiropractic statement is either something Medicare does not cover when a chiropractor furnishes it, or something the office prices on its own list. The rest of the arithmetic follows from that.

2026 approved amounts for 98940, 98941 and 98942

The amounts below come from the CMS CY2026 relative value file (RVU26D, October 2026 release) weighted by the Michigan Locality 01 indices (work 1.000, practice expense 0.965, malpractice 1.686) and multiplied by the $33.4009 conversion factor the file lists for clinicians who are not qualifying alternative payment model participants. The nonfacility column is the office amount, which is where chiropractic visits are normally billed. The last two columns are a 20 percent share of that amount and the limiting charge explained further down.

Source: CMS PFS RVU26D (PPRRVU2026_Oct_nonQPP) and GPCI2026, Michigan Locality 01, CY2026, participating amounts per visit. Limiting charge = amount x 1.0925, per the RVU26D documentation. Computed and checked October 31, 2026. Medicare anchors, not your bill.

Each step from one code to the next adds between eleven and twelve dollars of approved amount, and a little over two dollars of coinsurance. The difference between a two-region visit and a five-region visit is $22.82 in Medicare terms and $4.56 in a 20 percent share. That is small per visit, but it compounds over a course of visits, which is where the yearly table below comes in.

Here is the arithmetic for 98941, so the method can be checked against the CMS file. RVU26D lists 0.69 work units, 0.45 nonfacility practice expense units and 0.01 malpractice units. At the Detroit indices that becomes 0.69 x 1.000 plus 0.45 x 0.965 plus 0.01 x 1.686, which is 1.14111 adjusted units. Multiplied by $33.4009, that is $38.11. The RVU26D documentation gives the formula in the same terms, and the result for each code is rounded to the cent.

The file also carries a facility amount, which uses a smaller practice expense value because a hospital or other facility supplies the space and staff. For 98941 that figure is $28.12 in Michigan Locality 01. A chiropractic visit in a private office is billed at the nonfacility amount; the facility figure applies only when the service is furnished in a facility setting, which is uncommon for chiropractic. RVU26D also lists a second conversion factor, $33.5675, for qualifying alternative payment model participants; the figures here use the $33.4009 factor that applies to most clinicians.

Active treatment, maintenance, and the AT modifier

Section 240.1.3 of chapter 15, "Necessity for Treatment," is where most chiropractic coverage questions are decided. It says the patient must have a significant neuromusculoskeletal health problem, and that the manipulation must have a direct therapeutic relationship to that condition and provide a reasonable expectation of recovery or improvement of function. It then sorts spinal joint problems into two categories for Medicare purposes. An acute subluxation is a new injury, where manipulation is expected to improve the condition or arrest its progression. A chronic subluxation is one not expected to significantly improve or resolve with further treatment, but where continued therapy can be expected to bring some functional improvement.

The billing switch sits between those definitions and the claim. In the manual's words, a chiropractor must place an AT modifier on a claim when providing active or corrective treatment for an acute or chronic subluxation. The AT modifier tells the Medicare contractor that the visit is active care. The manual adds that the presence of the AT modifier may not in all instances indicate that the service is reasonable and necessary, and that contractors may deny after medical review. AT is a statement by the chiropractor, not a pre-approval.

Maintenance therapy is the other side of the line. The manual defines it as services that seek to prevent disease, promote health and prolong and enhance the quality of life, or maintain or prevent deterioration of a chronic condition. When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the treatment becomes supportive rather than corrective, the manual says it is maintenance therapy, and once a condition's clinical status has remained stable without expectation of additional objective improvement, further manipulative treatment is maintenance and not covered. The instruction to chiropractors is plain: the AT modifier must not be placed on the claim for maintenance therapy, and claims without the AT modifier will be considered maintenance therapy and denied.

Sources: Medicare Benefit Policy Manual chapter 15, section 240.1.3 (Rev. 23); Medicare Claims Processing Manual chapter 23, section 20.9.1.1 (GZ claim lines denied automatically); chapter 30, sections 50 and 50.9. Checked October 31, 2026.

Whether a given visit is active or maintenance is a clinical judgment, and this site does not weigh in on it. What a patient can see is the result on paper. The Medicare Summary Notice, or the chiropractor's own claim copy, shows whether the AT modifier was used. A run of visits billed with AT, followed by visits billed without it or with GA, is the moment the billing moved from covered visits to visits the office expects you to pay for yourself, and it is worth asking the office directly when that change happened and why.

The manual also gives a time frame that contractors use when they review claims. Section 240.1.5 says acute problems, for example strains or sprains, may require as many as three months of treatment, though some require very little, with frequent visits in the first several days that decrease as improvement is obtained. A chronic condition may require a longer treatment time, but not with higher frequency. Those sentences are not a visit cap, and Medicare publishes no fixed number of covered chiropractic visits per year; they describe the pattern that medical review compares a claim history against.

What Medicare never pays a chiropractor for

The same section that defines the covered service lists what is excluded. Section 240.1.1 says no other diagnostic or therapeutic service furnished by a chiropractor or under the chiropractor's order is covered. It spells out the effect on imaging: if a chiropractor orders, takes or interprets an X-ray or any other diagnostic test, the test can be used for claims processing purposes, but Medicare coverage and payment are not available for it. Medicare.gov's chiropractic page puts it in a sentence: Medicare doesn't cover other services or tests a chiropractor orders, including X-rays, massage therapy and acupuncture.

Sources: Medicare Benefit Policy Manual chapter 15, sections 240.1.1 and 240.1.2; Medicare.gov, Chiropractic services; CMS PFS RVU26D and GPCI2026, Michigan Locality 01, CY2026. Checked October 31, 2026. Medicare anchors, not your bill.

The X-ray row needs care, because a spine X-ray can be a covered Medicare service, just not from a chiropractor. Section 240.1.1 says the prohibition does not affect coverage of X-rays furnished by other practitioners, and gives the example of an X-ray taken to demonstrate a subluxation, which is a covered diagnostic test if ordered, taken and interpreted by a doctor of medicine or osteopathy. In that case the CY2026 Michigan Locality 01 global anchor for a two- or three-view low back film, 72100, is $39.73, and a 20 percent share after the deductible is $7.95. The lumbar spine X-ray price page covers that code in both an office and a hospital outpatient department.

Since January 1, 2000, an X-ray has not been required to show a subluxation; section 240.1.2 says a physical examination can document it instead, and section 240.1.1 says an X-ray may still be used if the chiropractor chooses. The billing consequence is that a chiropractor's in-office X-ray is a line the patient pays for under the office's own price, even when it is used to support a covered manipulation claim. If an X-ray is used, the manual expects it to be reasonably close in time to the start of the course of treatment: no more than 12 months before or 3 months after it, with older films accepted in some chronic cases. Chapter 12, section 220, of the claims manual adds that the date of the X-ray goes in item 19 of the claim form.

CPT 98943 is the code for manipulation of regions outside the spine, and the RVU26D file is explicit about it. The code carries status N, which the file's documentation defines as "Non-covered Services. These services are not covered by Medicare." The file still prints relative value units for it, 0.45 work, 0.31 nonfacility practice expense and 0.03 malpractice, 0.79 in total, but the same documentation says that only RVUs associated with status codes A, R or T are used for Medicare payment. Those numbers are reference values, not a payment amount, and no Medicare anchor for 98943 is published here.

The exam deserves a separate sentence, because it is the line patients are most often surprised by. A chiropractic office will commonly bill an evaluation on the first visit and at intervals after that. When a chiropractor furnishes it, it falls under section 240.1.1's "no other diagnostic or therapeutic service" sentence, so Medicare pays nothing toward it, and no Medicare amount for it applies to a chiropractor. The price is whatever the office charges, which is exactly why it should be asked for before the visit. The same is true of physical therapy ordered by a chiropractor; physical therapy furnished under a physician's or other qualified practitioner's plan of care is a separate Medicare benefit, priced code by code in the guide to physical therapy cost per visit.

Where an ABN is required and where it is optional

An Advance Beneficiary Notice of Noncoverage, Form CMS-R-131, is the written notice that lets a provider bill a Medicare patient for a service Medicare is expected to deny. For a chiropractor, two kinds of noncoverage meet on one statement, and the Medicare Claims Processing Manual, chapter 30, treats them differently.

Maintenance manipulation is denied because Medicare considers it not reasonable and necessary. Section 50.2 of chapter 30 lists section 1862(a)(1) of the Social Security Act, "not reasonable and necessary," first among the provisions that necessitate delivery of the ABN. Chapter 15, section 240.1.3, ties this to chiropractic directly: chiropractors who give an ABN follow the claims manual's instructions and include a GA modifier on the claim, or in rare instances a GZ modifier. So when a chiropractor expects a visit to be denied as maintenance, a notice before the visit is what moves the cost to the patient.

The exam, the chiropractor's X-rays and 98943 are different. They are not denied as unnecessary; they are outside the chiropractic benefit altogether. Section 50.2.1 of chapter 30 says ABNs are not required for care that is statutorily excluded from Medicare or that fails to meet the definition of a Medicare benefit, although CMS strongly encourages providers to issue one for care that is never covered. In plain terms, the office can bill you for a chiropractic exam or X-ray without having given you an ABN first. A notice for those lines is a courtesy, not a condition of billing.

Sources: Medicare Claims Processing Manual chapter 30, sections 50, 50.2, 50.2.1, 50.8 and 50.9 (Rev. 12934); Medicare Benefit Policy Manual chapter 15, section 240.1.3. Checked October 31, 2026.

When a valid ABN is signed, the price is no longer the fee schedule amount. Section 50.9 of chapter 30 says a beneficiary who has been given a properly delivered ABN and agrees to pay may be held liable, and that the charge may be the provider's usual and customary fee for that service, not limited to the Medicare fee schedule. So the $38.11 anchor for 98941 tells you what Medicare would have approved for an active-care visit; it does not cap what a maintenance visit under a signed notice can cost. The form's estimated-cost field is where the office's figure belongs, and the guide to the Advance Beneficiary Notice walks through each part of the form, the three options and what each does to your appeal rights.

Chiropractic care tends to be repetitive, and chapter 30 has a rule written for that. Section 50.8 says a provider may give one ABN describing an extended or repetitive course of non-covered treatment, listing every service and the duration of the period of treatment, and that the notice stays effective as long as the care, the patient's condition and Medicare's coverage guidelines do not change. It may be reissued after one year. The same section closes a gap that matters on a bill: if repetitive non-covered care started before the notice was given, the ABN can be issued during the course of treatment, but it cannot be retroactively dated or used to shift liability for care provided before it was issued. The manual says that earlier care is the provider's financial responsibility.

Chapter 30 also rules out a shortcut some offices use. Section 40.2.2 says generic written notices, which only say that Medicare might deny something, and blanket notices given for every claim are not acceptable and will not protect the notifier. A notice has to name the service and give a genuine reason that denial is expected for that patient. A form signed at the first visit that says, in effect, "you agree to pay for anything Medicare does not" is not an ABN for a maintenance visit months later.

A 12-visit course priced with and without the deductible

The rows below price twelve visits of each code at the Michigan Locality 01 amounts. Twelve is an arbitrary count chosen to make a year's arithmetic visible; it is not a number of visits Medicare allows, a typical plan of care, or a recommendation. The calculation assumes every visit is billed with the AT modifier and paid as covered, the chiropractor accepts assignment, and there are no other Part B claims in the year, so the chiropractic visits are the first to meet the $283.00 deductible.

Source: CMS PFS RVU26D and GPCI2026, Michigan Locality 01, CY2026; 2026 Part B deductible $283.00 from Medicare.gov. The visit count is an example, not a norm. Computed October 31, 2026. Medicare anchors, not your bill.

Take the 98941 row step by step. Twelve visits at $38.11 are $457.32 in approved amounts. With the deductible already met, for example by other Part B services earlier in the year, the share is 20 percent of that, $91.46, and Medicare pays $365.86. With the deductible not yet met, the first $283.00 of approved amounts goes entirely to the deductible. That leaves $174.32 on which the 20 percent coinsurance applies, $34.86, for a total of $317.86 out of pocket and $139.46 paid by Medicare.

The deductible dominates the year for small, frequent claims like these. For 98940, twelve visits total $318.60, barely above the deductible, so a patient starting the year at zero pays $290.12 of it and Medicare pays only $28.48. On the 98942 row the gap between the two columns is smaller in proportion, $118.49 against $344.89, because more of the approved total sits above the deductible. The deductible is met once per year across all Part B services, so if the chiropractic visits come after other Part B claims, the left column is the one that applies, and if they come in January, the right one does.

Visits in the year can be split across codes, and the table's rows do not need to be read as all-or-nothing. A patient whose first four visits are billed 98941 and whose next eight are 98940 can add the pieces: four times $38.11 plus eight times $26.55 is $364.84 in approved amounts, and the same deductible-then-20-percent rule applies to the sum. Any visits billed without AT, or with GA under a signed ABN, drop out of this arithmetic entirely and are priced at the office's charge.

Participating, nonparticipating and the 1.0925 ceiling

The share in the tables above assumes the chiropractor accepts assignment, meaning it accepts the Medicare-approved amount as full payment for the covered service. Chapter 15, section 240, says chiropractic payment is based on the physician fee schedule and is made to the beneficiary or, on assignment, to the chiropractor. That wording allows for claims the chiropractor does not take on assignment, so three billing arrangements can apply to the same covered visit.

Sources: CMS PFS RVU26D documentation (limiting charge factor 1.0925) and GPCI2026, Michigan Locality 01, CY2026; Medicare Claims Processing Manual chapter 12, section 20.4.1 (nonparticipant payments capped at 95 percent of the fee schedule amount). Computed October 31, 2026. Medicare anchors, not your bill.

The bottom row is built from the RVU26D documentation. The law sets the limiting charge at 115 percent of the nonparticipating payment amount, and the nonparticipating amount at 95 percent of the participating fee schedule amount; 95 percent of 115 percent is a factor of 1.0925. For 98941 that is $38.11 x 1.0925 = $41.64, the most a nonparticipating chiropractor may charge for that visit in Michigan Locality 01. Medicare's approved amount is 95 percent of the fee schedule figure, $36.20, and Medicare pays 80 percent of that, $28.96, to the patient rather than the chiropractor. The patient pays the chiropractor the $41.64 and is reimbursed $28.96, a net $12.68 per visit.

Over the 12-visit course with the deductible met, that gap adds up: $152.16 net with an unassigned nonparticipating chiropractor against $91.46 with a participating one, and $86.88 with a nonparticipating chiropractor who accepts assignment. The limiting charge applies to covered services. It is not the ceiling for a maintenance visit under a signed ABN, where section 50.9 of chapter 30 allows the usual and customary fee, or for the exam and X-ray lines Medicare does not cover. Before the first visit, ask the office one direct question: does it participate in Medicare, and if not, does it accept assignment? Twelve other common codes are priced at the same ceiling in the guide to Medicare excess charges, with the Plan G and Plan N split.

Checking a Medicare Summary Notice against the visit

Chiropractic claims are short, which makes them easy to check. Each covered visit should show one of the three manipulation codes, once per date of service. The approved amount should match the locality figure for that code, or 95 percent of it for a nonparticipating chiropractor. Where the notice shows a denial, the reason code and the modifier explain whether the office expected it.

The denial row is the one with money behind it. If the office billed you for a maintenance visit that Medicare denied and you never signed an ABN for it, chapter 30 says you are relieved from liability, and section 50.8 says a notice signed partway through a course does not reach back to earlier visits. A written question to the billing office, naming the dates, is the first step: "Medicare denied these visits; please show me the signed ABN that covered each of them, or remove the charges." If a denial looks wrong, the Medicare Summary Notice explains how to request a redetermination, and the guide to appealing a denial covers the general sequence. For Medicare costs beyond chiropractic, the Medicare and Medicaid costs hub collects the related guides, and the guide to Medicare outpatient procedure costs applies the same deductible and 20 percent arithmetic to larger services.

Medigap, Medicare Advantage and paying cash

The 20 percent share above is the Original Medicare figure before any supplemental coverage. A Medigap policy pays some or all of the Part B coinsurance on covered services, depending on the plan letter, so for an active-care visit billed with AT, the patient's out-of-pocket share can be lower than the table shows. Medigap follows Medicare's coverage decision: it pays toward the coinsurance on a visit Medicare covers, not toward a maintenance visit Medicare denies or an exam Medicare does not cover.

A Medicare Advantage plan covers the Part B chiropractic benefit too, but it sets its own cost sharing, which can be a flat copay per visit instead of 20 percent, and it may require the chiropractor to be in its network. A plan can also offer routine chiropractic visits as an extra benefit beyond the Part B rule. Those amounts are plan-specific, and no Medicare Advantage figure is published here. The plan's Evidence of Coverage document, or its member services line, gives the copay and any visit limit; ask whether a visit is covered as the Part B benefit or as a supplemental one, because the two can carry different copays.

Visits and lines Medicare does not cover are paid out of pocket or by other coverage. No self-pay range is published on this page, because none met the site's verification rule. The Medicare figure above shows the order of magnitude Medicare places on each visit; the office's own price for the exam, any X-ray and any maintenance visit is the number to get in writing. If you are uninsured or not using insurance for a scheduled service, the federal Good Faith Estimate rules may apply, and the guide on Good Faith Estimates explains when a provider must give one.

A short request to the front desk covers everything that varies: "For a Medicare patient, do you participate or accept assignment? Which code do you expect to bill for my visits, and will you bill them with the AT modifier? What do you charge for the first exam and for any X-ray? If you expect Medicare to stop paying, will you give me an ABN first, and what will a visit cost then?" Each answer maps to a row in the tables above.

The same three codes in ten localities

Every Medicare payment locality has its own three indices, so the same manipulation pays a different amount in Detroit, rural Mississippi or Manhattan. The table applies the CY2026 GPCI file to the same RVU26D values for a spread of localities, low-cost and high-cost, with the national row at indices of 1.000 for reference.

Source: CMS PFS RVU26D nonfacility RVUs and CY2026 GPCI file (Addendum E of the CY2026 final rule), $33.4009 conversion factor, participating amounts. Computed October 31, 2026. Medicare anchors, not your bill.

The national row is the simplest check: 98940 carries 0.80 total nonfacility units, and 0.80 x $33.4009 is $26.72. Among the localities listed, 98941 runs from $36.23 in Mississippi (statewide) to $50.76 in Alaska (statewide), a difference of $14.53 per visit. The 20 percent share moves less, and over twelve 98941 visits with the deductible met the gap between those two localities is $34.87. Alaska's high figure comes mostly from its work index of 1.500, which the GPCI file's footnote attributes to a 1.5 floor for Alaska set by MIPPA. At the other end, the work index of 1.000 in Mississippi, Alabama and Rest of Michigan reflects the national 1.0 work floor, which the same file says was extended through January 1, 2027, by section 6208 of the Continuing Appropriations Act, 2026.

The Michigan Locality 01 figure used in the other tables ($38.11 for 98941) sits a little under the national figure, because its practice expense index of 0.965 outweighs its high malpractice index on a code where malpractice units are tiny. CMS publishes a Physician Fee Schedule lookup tool on its website for any locality's figure, and the claim's Medicare Summary Notice shows the approved amount Medicare actually used.

Medicare chiropractic billing questions

Benefit manuals and fee files for the chiropractic figures

• CMS, Medicare Benefit Policy Manual, chapter 15 (Rev. 13889, issued 07-30-26), section 240 (chiropractic services), 240.1.1 (manual manipulation, devices, services not covered, X-rays), 240.1.2 (subluxation shown by X-ray or exam), 240.1.3 (necessity for treatment, AT modifier, maintenance therapy, ABN and GA/GZ), 240.1.4 (location of subluxation) and 240.1.5 (treatment parameters, one treatment per day). Checked October 31, 2026.
• CMS, Medicare Claims Processing Manual, chapter 30 (Rev. 12934), sections 40.2.2 (generic and blanket notices), 50 (compliance and provider liability), 50.2 (required ABN uses), 50.2.1 (optional ABN uses), 50.8 (repetitive care) and 50.9 (beneficiary liability, usual and customary fee). Checked October 31, 2026.
• CMS, Medicare Claims Processing Manual, chapter 23 (Rev. 13701), section 20.9.1.1 (claim lines with the GZ modifier denied automatically). Checked October 31, 2026.
• CMS, Medicare Claims Processing Manual, chapter 12 (Rev. 13753), section 20.4.1 (nonparticipant payments at 95 percent) and section 220 (chiropractic claims, X-ray date in item 19). Checked October 31, 2026.
• CMS, Physician Fee Schedule relative value file RVU26D (October 2026 release, PPRRVU2026_Oct_nonQPP released 08/26/2026) and CY2026 GPCIs: RVUs and status for 98940 to 98943, 72040 and 72100, the payment formula, status N and A definitions, the rule that only A, R and T RVUs are used for payment, the 1.0925 limiting charge factor and the $33.4009 and $33.5675 conversion factors. Computed October 31, 2026.
• Medicare.gov, Chiropractic services: Part B coverage of spinal adjustments, services not covered, 20 percent after the deductible. Checked October 31, 2026.
• Medicare.gov, Medicare costs, 2026 Part B deductible of $283.00. Checked October 30, 2026.

General billing information, not medical, legal or insurance advice. Medicare anchors are not your bill, and a chiropractor's own charges and a plan's allowed amounts can differ from them. Confirm your price in writing before service.