Summary & Overview
CPT 98940: Spinal Manipulation, One to Two Regions
CPT code 98940 represents manual spinal manipulation performed by a qualified provider targeting one to two spinal regions. This procedure is commonly used to address joint dysfunction and to modulate neurophysiological function as part of musculoskeletal and pain management care. Nationally, spinal manipulation is a frequently billed modality across primary care, specialty outpatient practices, and chiropractic settings, with implications for coverage policies, documentation standards, and appropriate use criteria.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for use of 98940, typical sites of service, common billing considerations, and where variations in payer coverage and requirements often arise. The publication outlines benchmarks and policy drivers relevant to reimbursement and claims adjudication, highlights documentation elements that commonly affect medical necessity determinations, and summarizes related coding considerations for services involving spinal manipulation.
This summary is intended for billing managers, practice administrators, and clinicians seeking a national-level briefing on the role of CPT code 98940 in outpatient musculoskeletal care and payer interactions.
Billing Code Overview
CPT code 98940 describes a provider-performed spinal manipulation procedure that applies techniques and modalities to influence joint and neurophysiological function in one to two spinal regions. The service is a manual therapy intervention focused on restoring or improving spinal joint mobility and neurophysiological responses through hands-on manipulation techniques.
Service type: Spinal manipulation / manual therapy
Typical site of service: Outpatient clinic, physician office, or chiropractic clinic
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Clinical & Coding Specifications
Clinical Context
A 42-year-old patient presents to an outpatient musculoskeletal clinic with a 4-week history of mechanical low back pain radiating intermittently into the left buttock after a workplace lifting incident. Prior conservative care included nonsteroidal anti-inflammatory medication and a single session of physical therapy with limited benefit. The evaluating clinician (a chiropractor or a physical medicine and rehabilitation physician) performs a focused history and musculoskeletal/neurologic exam, documents segmental hypomobility of the lumbar spine in one to two spinal regions, and determines spinal manipulation is clinically indicated to influence joint mechanics and neurophysiologic function.
During the visit the provider obtains informed consent, documents the body regions treated (lumbar and sacral regions), the manipulation techniques used (high-velocity, low-amplitude thrust and soft tissue mobilization), objective findings (reduced range of motion, segmental tenderness, improved passive motion after treatment), and immediate post-procedure status. The encounter is billed as 98940 (manipulation of one to two spinal regions). Typical follow-up includes reassessment of pain, function, and need for additional manipulation, coordination with physical therapy if needed, and appropriate documentation of medical necessity for each subsequent visit.
Typical site of service is an outpatient clinic such as a chiropractic office, private orthopedics or physiatry clinic, or ambulatory care center. The service type is a therapeutic manual therapy procedure (spinal manipulation).
Coding Specifications
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