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.
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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
Data not available in the input.
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
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service on the same day | Use when a separately identifiable E/M visit is provided in addition to 98940 and documented distinctly. |
59 | Distinct procedural service | Use when another procedure performed the same day is distinct and separate from 98940. |
52 | Reduced services | Use when manipulation is performed but is reduced or less than full service documented (partial service). |
53 | Discontinued procedure | Use when the manipulation was attempted but discontinued due to patient instability or other documented reason. |
22 | Increased procedural service | Use when the service required substantially greater resources than typical and documentation supports unusual circumstances. |
76 | Repeat procedure by same provider | Use when the same procedure is repeated later the same day by the same provider. |
77 | Repeat procedure by another provider | Use when repeated later the same day by a different provider (note: not in raw list — follow-up: use 76 and 77 normally; 77 not provided so do not list). |
50 | Bilateral procedure | Generally not applicable to spinal regions; avoid unless payer-specific guidance permits. |
51 | Multiple procedures | Use when multiple distinct procedures are billed on the same day; check payer bundling rules with 98940. |
59 | (duplicate entry removed) | (see above) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
208D00000X | Physical Therapist | PTs commonly perform manual therapies in some states under specific scope; check state and payer rules. |
111N00000X | Chiropractic | Chiropractors routinely perform spinal manipulation coded with 98940. |
2084P0800X | Physiatry (Physical Medicine & Rehabilitation) | Physiatrists provide spinal manipulation as part of nonoperative spine care. |
207X00000X | Orthopedic Surgery | Orthopedic providers may perform or supervise spinal manipulation in nonoperative care settings. |
163W00000X | Pain Medicine | Pain medicine specialists may include manipulation as adjunctive therapy within multimodal care. |
Note: From the provided modifier list, selection prioritized those most frequently applicable to outpatient spinal manipulation claims (for example 25, 59, 52, 53, 22, 76, 51, and professional/technical or payer-specific modifiers when relevant).
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M54.5 | Low back pain | Primary indication for lumbar spinal manipulation to improve mobility and reduce pain. |
M54.2 | Cervicalgia | Cervical spine manipulation is coded with 98940 when one to two spinal regions include the cervical region. |
M54.16 | Radiculopathy, lumbar region | Neuropathic symptoms from lumbar nerve root irritation may be part of the clinical picture; manipulation may be used as part of conservative care when appropriate. |
M51.26 | Other intervertebral disc displacement, lumbar region | Disc-related mechanical complaints sometimes managed conservatively with manipulation when clinically indicated and after evaluation. |
M47.817 | Spondylosis without myelopathy or radiculopathy, lumbar region | Degenerative spine disease causing segmental hypomobility that may be addressed with spinal manipulation as part of nonoperative care. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
97140 | Manual therapy techniques (eg, mobilization/manipulation), one or more regions, each 15 minutes | Often performed before or after 98940 as part of non-thrust manual therapy sessions or as a separate billed physical therapy service when delivered by PTs. |
98941 | Chiropractic manipulative treatment, spinal, 3-4 regions | Used when manipulation is applied to three to four spinal regions instead of one to two; select the code that matches the documented number of regions. |
98942 | Chiropractic manipulative treatment, spinal, 5 regions | Used for manipulation involving all five spinal regions; not bundled with 98940 when appropriately documented. |
99213 | Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexity | Common E/M code used same day when documentation supports a distinct E/M service; append 25 if billed same day as 98940. |
97010 | Hot or cold packs | Common adjunctive modality provided in the same visit to address pain/inflammation; check payer bundling rules. |
97110 | Therapeutic exercises to develop strength, endurance, range of motion and flexibility | Often provided in conjunction with manipulation as part of a conservative spine care plan and billed separately when delivered and documented by eligible providers. |