CPT Code 98941: Documentation, the AT Modifier, and 2026 Reimbursement

What Is CPT Code 98941?

CPT code 98941 is the chiropractic manipulative treatment (CMT) code for a spinal adjustment that covers three to four of the five spinal regions in a single visit. It is the most frequently billed CMT code in chiropractic, and it is selected by the number of spinal regions treated, not the number of adjustments performed, which is where most coding errors and denials begin.

• Regions, not adjustments: You bill 98941 when three or four of the five spinal regions are treated. Three adjustments to one region is still 98940, not 98941.
• The AT modifier is mandatory: Medicare requires the AT modifier on every 98941 claim to signal active treatment. Without it, the claim is denied as maintenance care with no appeal.
• 2026 reimbursement: Medicare pays roughly 45 to 52 dollars for 98941 in a non-facility setting nationally, before geographic adjustment.

What CPT 98941 Covers

CPT 98941 reports chiropractic manipulative treatment of the spine when three or four spinal regions are adjusted in one encounter. As maintained by the American Medical Association, the CMT family is defined entirely by how many of the five spinal regions receive treatment: 98940 covers one to two regions, 98941 covers three to four, and 98942 covers all five. A separate code, 98943, covers extraspinal manipulation such as the extremities, and Medicare does not cover it.

The five spinal regions recognized by CMS are cervical, thoracic, lumbar, sacral, and pelvic. 98941 is the workhorse of the family because a large share of chiropractic visits involve related complaints across the neck, mid back, and low back at once. For a fuller map of the codes chiropractors bill alongside CMT, see our overview of chiropractic CPT codes.

The treatment itself is a hands-on service: the chiropractor applies controlled, high-velocity, low-amplitude thrusts or similar manual techniques to correct subluxation and restore motion. That hands-on requirement matters for billing, because the code has to reflect a manipulation actually performed on each region counted. In our experience matching chiropractors with billing partners, practices that treat 98941 as a default rather than a documented choice are the ones that draw payer scrutiny.

How Do You Count Spinal Regions for 98941?

You count spinal regions, not adjustments. 98941 applies when a chiropractor manipulates three or four of the five recognized spinal regions in one visit. Three separate adjustments within a single region still count as one region, so that visit is 98940, not 98941. The number of thrusts never drives the code.

The math is simple once you anchor on regions. Cervical plus thoracic plus lumbar is three regions and bills 98941. Cervical and lumbar alone is two regions and bills 98940. All five regions bills 98942. These are the five regions CMS recognizes for CMT counting:

• Cervical region, the seven vertebrae of the neck.
• Thoracic region, the twelve vertebrae of the mid back.
• Lumbar region, the five vertebrae of the lower back.
• Sacral region, at the base of the spine.
• Pelvic region, treated as its own region for CMT counting.

The most common CMT coding mistake, and one of the top denial drivers we see, is selecting the code from the number of adjustments instead of the number of regions. Documentation has to name each region treated. A note that says three regions were adjusted, without naming them, may not survive an audit.

The AT Modifier and Medicare

For Medicare, the AT modifier is not optional. Append it to every 98941 claim to signal active, corrective treatment. Medicare covers chiropractic manipulation only for active treatment of a documented subluxation, and it does not cover maintenance care. A 98941 claim submitted without the AT modifier is read as maintenance by default and denied automatically, with no appeal pathway, no matter what the note says.

The line between active and maintenance is the other half of the trap. Even with the AT modifier attached, if the record shows a patient who has plateaued over many visits with no measurable functional improvement, Medicare can reclassify the ongoing care as maintenance and deny it. Two other modifiers come up here: GA when a signed Advance Beneficiary Notice is on file and you expect a denial, and GZ when no notice is on file and you expect the service to be non-covered.

Across the chiropractic billing companies we vet, the strongest operators treat the AT modifier and the active-care narrative as a single discipline, while the weak ones bolt the modifier on without documenting improvement. Providers often come to us after a wave of Medicare CMT denials that all trace back to this one gap.

98940 vs 98941 vs 98942

The CMT family is easy to bill correctly once you anchor on region count. This is the comparison that resolves most of the confusion in one place.

Approximate national averages under the 2026 CMS Physician Fee Schedule, non-facility setting, before geographic adjustment. Extraspinal manipulation (98943) is billed separately and is not covered by Medicare. Verify current rates with your MAC.

The dollar gaps look small per visit, but a chiropractic practice runs these codes at high volume. Consistently billing 98940 on visits that supported 98941, or the reverse, moves real money across a year and is a frequent audit flag either way. One question we hear constantly from chiropractic practice managers is whether they should round up to 98941 to capture more revenue. The answer is no. The code has to match the regions actually treated and documented. Upcoding to 98941 without support invites recoupment, and downcoding out of caution leaves earned revenue on the table. Accuracy, not direction, is the goal.

How Much Does 98941 Pay in 2026?

Medicare pays roughly 45 to 52 dollars for CPT 98941 in a non-facility setting in 2026, based on national averages before geographic adjustment. The exact amount depends on your locality and, new for 2026, your Alternative Payment Model status, because CMS now uses two separate conversion factors.

Payment equals total RVUs multiplied by the conversion factor, then adjusted for locality by the Geographic Practice Cost Index. For 2026 the conversion factor is 33.40 dollars for non-qualifying providers and 33.57 dollars for qualifying Alternative Payment Model participants, the first year Medicare has run two factors. The same 98941 therefore pays more in a high-cost metro than in a rural market.

Commercial payers such as Aetna, Cigna, and Blue Cross Blue Shield set their own CMT rates by contract and often pay above Medicare, but many cap visit frequency and require the same documentation. Always verify the figure against your own contracts and your MAC fee schedule before relying on it for budgeting.

Documentation and Common Denials

Chiropractic CMT is one of the most audited services in outpatient care, and 98941 draws more scrutiny than 98940 because it claims more regions. Most denials trace back to a short list of fixable documentation gaps.

• Name the regions treated. The note must specify each of the three or four regions, not just state a count.
• Document a subluxation. Medicare requires a documented subluxation in each region, supported by exam findings.
• Apply the AT modifier correctly. Every active-care Medicare claim needs it, and the record has to back up active treatment.
• Show functional improvement. Progress notes should demonstrate measurable gains, or the care risks being called maintenance.
• Use modifier 25 for same-day E/M. Billing an evaluation and management service with 98941 needs modifier 25, or the E/M bundles and denies.
• Pair accurate ICD-10 codes. Diagnosis codes should map to each region treated and support medical necessity.

In our experience matching chiropractors with billing partners, the practices with the cleanest 98941 claims are not the ones with the fanciest software. They are the ones whose notes name the regions, prove the subluxation, and show the patient getting better.

In-House vs Outsourced Billing

Whether to keep chiropractic billing in house or outsource it comes down to volume, Medicare exposure, and how often 98941 claims are getting denied. A small, cash-heavy practice with few Medicare patients may bill well internally. A busy practice with heavy Medicare and commercial volume, where CMT denials are stacking up, often finds a specialized partner recovers more than the service costs by fixing region counts, modifiers, and documentation.

The honest test is whether your practice can say how many 98941 claims were denied last quarter and why. If you cannot, that blind spot is exactly where revenue leaks. Providers often come to us after months of unexplained CMT denials, and a good partner audits the region counts and the AT-modifier discipline first. For a practical starting point on evaluating partners, see our guide on how to find the right chiropractic medical billing service.

Frequently Asked Questions