CPT Code 98943: Billing Extraspinal Chiropractic Manipulation

When Do You Bill CPT Code 98943?

CPT code 98943 is the chiropractic manipulative treatment (CMT) code that reports manipulation of one or more extraspinal regions, meaning joints outside the spine such as the shoulders, elbows, wrists, hips, knees, ribs, and the temporomandibular joint. You bill it when you adjust an extraspinal region and document a distinct problem there. Medicare never covers 98943, so payment depends entirely on commercial and Medicaid policy.

• What 98943 covers: It reports extraspinal manipulation across five recognized regions and is billed separately from the spinal CMT codes 98940 through 98942.
• Why Medicare excludes it: Medicare’s chiropractic benefit is limited by statute to spinal manipulation, so 98943 is statutorily excluded and cannot be paid or appealed.
• The same-day rule: When you bill 98943 with a spinal CMT code on one visit, check the payer’s policy and append modifier 59 or XS where it is required, pointing it to a distinct extraspinal diagnosis.

CPT code 98943 is the one chiropractic manipulative treatment code that steps outside the spine. It reports extraspinal adjustments to the extremities, ribs, and jaw, and it behaves differently from every spinal CMT code in the family. Medicare excludes it outright, commercial coverage varies, and the modifier rules trip up practices constantly. Used correctly, 98943 captures legitimate revenue for extremity work that many chiropractors leave on the table. This guide explains what 98943 covers in 2026, why Medicare never pays it, and how to bill it cleanly alongside spinal manipulation.

What Is CPT Code 98943?

CPT code 98943 describes chiropractic manipulative treatment of one or more extraspinal regions. The AMA CPT code set defines it as manipulation applied to influence joint and neurophysiological function in regions outside the spine, which sets it apart from the spinal CMT codes 98940 through 98942 that are scored by spinal region count. Unlike those codes, 98943 is not scored by how many extraspinal regions you treat. One region or several, it is still a single 98943.

That single-unit structure is the first thing practices misread. In our experience matching providers with billing partners, one of the most common patterns is a chiropractor who either never bills 98943 for legitimate extremity work or bills it as if extra regions add units. Neither is right. The code is reported once per visit when an extraspinal adjustment is performed and documented, regardless of how many extremity joints were involved.

The Five Extraspinal Regions

For 98943, the body outside the spine is divided into five recognized regions. Treating any one of them supports the code:

• Head region. Includes the temporomandibular joint, but excludes the atlanto-occipital joint, which is cervical spine.
• Upper extremities. Shoulders, elbows, wrists, and hands.
• Lower extremities. Hips, knees, ankles, and feet.
• Rib cage. Excludes the costotransverse and costovertebral joints, which count as thoracic spine.
• Abdomen. The remaining recognized extraspinal region.

The two exclusions matter. The atlanto-occipital joint belongs to the cervical spine and the costovertebral and costotransverse joints belong to the thoracic spine, so adjusting them is spinal CMT (98940 through 98942), not 98943. Coding those as extraspinal is a documentation error auditors catch quickly. For the full family, see our chiropractic CPT codes guide.

Does Medicare Cover CPT 98943?

No. Medicare’s chiropractic benefit is limited by statute to manual manipulation of the spine to correct a subluxation, so extraspinal code 98943 is statutorily excluded and never paid. It is not a medical-necessity denial you can appeal with better notes. When you must submit it to Medicare, append modifier GY to flag a statutorily excluded service.

When a patient wants the extraspinal service, the clean path is to bill Medicare with modifier GY, which flags the service as statutorily excluded and generates a denial you can use to bill a secondary payer or the patient. An Advance Beneficiary Notice is not required for a statutorily excluded service, though many practices still have the patient sign an acknowledgment so financial responsibility is clear up front. Providers often come to us after billing 98943 to Medicare expecting payment and treating the denial as something to appeal, when the fix is simply to route it correctly the first time.

How Do Commercial Payers Cover 98943?

Coverage for 98943 is entirely a commercial and Medicaid question, and it varies widely by plan. Some payers reimburse extraspinal manipulation, some bundle it into the spinal CMT, and some exclude it outright. Verify the specific plan’s chiropractic policy first, because the same practice can be paid for 98943 by one payer and denied by the next.

The practices that collect on 98943 consistently do two things: they confirm coverage before the visit rather than after the denial, and they document the extraspinal problem as clearly distinct from the spinal complaint. A shoulder adjustment billed with a spine-only diagnosis invites a bundling denial, while the same adjustment billed with a shoulder diagnosis and a note describing the extremity dysfunction stands on its own. Since Medicare excludes 98943 there is no Medicare allowable, and commercial rates follow your contracts. For context, the spinal CMT codes pay roughly $28 (98940), $38 (98941), and $47 (98942) nationally in 2026, and those rates are set to dip under the 2027 chiropractic Medicare payment changes.

Billing 98943 With Spinal CMT the Same Day

Most 98943 claims go out on the same visit as a spinal adjustment, and that is where the modifier discipline lives. When you bill 98943 alongside a spinal CMT code such as CPT 98940 or 98941, the two are separate and distinct procedures, and many payers will pay them together on the same date without a modifier at all. Others apply bundling edits to the pair. Where a payer does, append modifier 59, or the more specific XS for a separate structure, to the 98943 line and point it to the extraspinal diagnosis rather than the spinal subluxation code. Because this varies by payer, confirm the policy rather than assuming either outcome.

One modifier does not belong here: modifier 51. Per CPT Assistant (December 2013), 98943 and the spinal CMT codes are separate and distinct procedures, so modifier 51 does not apply. Worse, appending 51 signals the payer to treat 98943 as a lesser, reducible procedure, which can cut your reimbursement. The most common issue we see providers run into is reaching for modifier 51 out of habit on multi-procedure visits, when 59 or XS is the correct tool and 51 actively costs money.

Modifiers That Apply to 98943

• Modifier 59: Marks 98943 as a separate, distinct procedure from same-day spinal CMT so a payer that applies a bundling edit does not fold it into the spinal line. Point it to the extraspinal diagnosis.
• Modifier XS: A more specific alternative to 59 (separate structure), preferred by some payers for the distinct extraspinal site.
• Modifier GY: Flags 98943 as statutorily excluded when billed to Medicare, producing the denial needed to bill a secondary payer or the patient.
• Modifier 25: Append to a separately identifiable E/M performed the same day, on the E/M line, not on 98943 itself.
• Not modifier 51: CPT Assistant confirms 51 does not apply to 98943 and can reduce the payment.

98943 vs the Spinal CMT Codes

Seeing the extraspinal code against the spinal family makes the coverage and modifier differences clear. The spinal codes are scored by region count and covered by Medicare with the AT modifier; 98943 is extraspinal, single-unit, and outside the Medicare benefit.

Common 98943 Billing Mistakes

Across the billing companies we vet, the same extraspinal errors surface again and again. Each one is preventable with a pre-submission check.

• Skipping the code entirely. Many chiropractors never bill 98943 for legitimate extremity work, leaving covered revenue uncollected.
• Adding units for extra regions. 98943 is reported once per visit regardless of how many extraspinal regions were treated.
• Using modifier 51. It does not apply and signals the payer to reduce the 98943 payment.
• Omitting modifier 59 or XS where a payer requires it. With payers that apply a bundling edit to the pair, the 98943 line is folded into the same-day spinal CMT and denied.
• Pointing to the spinal diagnosis. The 98943 line needs a distinct extraspinal diagnosis, not the subluxation code.
• Expecting Medicare to pay. Medicare excludes 98943 by statute, so bill it with modifier GY and route the balance correctly.

In-House vs Outsourced for 98943

Extraspinal billing is low-volume and high-nuance, which is exactly the kind of work that slips through an overloaded in-house process. A practice that adjusts extremities regularly but cannot say which payers reimburse 98943, or whether its claims carry modifier 59 and a distinct diagnosis, is likely leaving money on the table or inviting bundling denials. This is the kind of gap Tim Daniels, Director of Strategic Accounts at Billing Service Quotes, looks for when reviewing whether a chiropractic practice captures the revenue it earns. If you want to compare partners who handle extraspinal coding correctly, Chiropractor Billers connects you with vetted chiropractic billing companies.

Frequently Asked Questions

Next Steps

• Billing spinal regions? See our guide to CPT 98940 for one-to-two-region manipulation.
• Need the full code set? Our chiropractic CPT codes guide covers the CMT family, therapy codes, and modifiers.
• Planning for rate changes? Read the 2027 chiropractic Medicare payment changes before the comment deadline.
• Ready to capture extraspinal revenue? Get matched with a chiropractic billing partner that codes 98943 correctly.