Running a chiropractic practice involves much more than patient care. Accurate medical coding is essential for getting paid on time. Mistakes in Chiropractic Coding and Billing can lead to claim denials, delayed payments, and lost revenue that’s why we created the billing for chiropractic services cheat sheet. With codes and regulations changing each year, staying current is a major challenge for many offices. This process requires attention to detail and a clear understanding of the latest updates from authorities like the Centers for Medicare & Medicaid Services. If you are strugling with ICD codes this is where expert medical billing for chiropractors can help streamline billing for chiropractic services.
This Chiropractic biling guide for practice owners is designed to be your goo-to chiropractic billing cheat sheet for 2026. We will break down the most common CPT, modifiers and compilance used in medical billing for Chiropractors. You will learn what these codes mean, how to use them correctly, and tips to avoid frequent billing errors. This will help you streamline your workflow, reduce claim rejections, and secure the reimbursement your practice deserves.
What Are CPT Codes and Why do I need a Chiropractic Billing Cheat Cheat?
CPT codes, or Current Procedural Terminology codes, describe the services you provide to a patient. Think of them as the “what you did” part of a claim. These five-digit codes tell insurance companies exactly what procedure or treatment was performed during a visit. For example, a CPT code specifies whether you performed a spinal adjustment, used mechanical traction, or conducted a new patient evaluation.
The American Medical Association (AMA) maintains and updates the CPT code set annually. Using the correct CPT code is critical for demonstrating the value of your services and receiving proper payment. If you use an outdated or incorrect code, the insurance payer will likely deny the claim.
Common Chiropractic CPT Codes for 2026
While there are thousands of CPT codes, chiropractic practices use a specific set on a regular basis. Here are the most important ones to know for 2025.
Chiropractic Manipulative Treatment (CMT) Codes
These are the core codes for chiropractors, representing spinal adjustments. The correct code depends on the number of spinal regions treated.
- 98940: Chiropractic manipulative treatment (CMT); spinal, 1-2 regions. This is used when you adjust the cervical and thoracic regions, for example.
- 98941: Chiropractic manipulative treatment (CMT); spinal, 3-4 regions. Use this code for adjustments covering more areas, such as the cervical, thoracic, and lumbar spine.
- 98942: Chiropractic manipulative treatment (CMT); spinal, 5 regions. This code covers adjustments to all five spinal regions: cervical, thoracic, lumbar, sacral, and pelvic.
- 98943: Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions. This is for adjustments performed on areas outside the spine, like the shoulder, wrist, or ankle.
Evaluation and Management (E/M) Codes
E/M codes are used for examining and evaluating a patient. These are typically used for new patients or for established patients with a new condition or a significant worsening of an existing one.
- New Patient Codes (99202-99205): These codes are for first-time patients. The specific code you choose depends on the complexity of the history, examination, and medical decision-making.
- Established Patient Codes (99212-99215): These are for follow-up visits with existing patients. Like new patient codes, the level is determined by the complexity of the visit.
Modalities and Therapeutic Procedures
These codes represent other treatments you provide to support the patient’s recovery. They are often used in conjunction with CMT.
- 97012: Application of a modality to 1 or more areas; mechanical traction.
- 97014: Application of a modality to 1 or more areas; electrical stimulation (unattended).
- 97110: Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion, and flexibility.
- 97140: Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes.
Understanding ICD-10-CM Codes for Chiropractors
If CPT codes are “what you did,” then ICD-10-CM codes are “why you did it.” These codes represent the patient’s diagnosis. The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) provides a highly detailed system for classifying diseases and health problems. You can find the official guidelines and code sets on the CDC’sICD-10-CM page. and you can check out our medical billing and coding guide for chiropractors as well.
Specificity is key with ICD-10. For example, instead of just using a code for “back pain,” you should use a code that specifies the exact location, like “low back pain.” This level of detail helps establish medical necessity, which is the foundation for getting a claim approved. Insurers want to see a clear link between the diagnosis and the treatment provided.
Top ICD-10 Codes for Chiropractic Billing Cheat Sheet in 2026
Here are some of the most frequently used ICD-10 codes in a chiropractic setting. Always code to the highest level of specificity supported by your documentation.
Segmental and Somatic Dysfunction Codes (M99 Series)
These are the bread-and-butter diagnosis codes for chiropractic care, often referred to as subluxation codes.
- M99.01: Segmental and somatic dysfunction of cervical region.
- M99.02: Segmental and somatic dysfunction of thoracic region.
- M99.03: Segmental and somatic dysfunction of lumbar region.
- M99.04: Segmental and somatic dysfunction of sacral region.
- M99.05: Segmental and somatic dysfunction of pelvic region.
Pain and Musculoskeletal Condition Codes
These codes are used to describe the patient’s symptoms and conditions.
- M54.2: Cervicalgia (neck pain).
- M54.5: Low back pain.
- M54.6: Pain in thoracic spine.
- M54.12: Radiculopathy, cervical region.
- M54.30: Sciatica, unspecified side.
- M62.830: Muscle spasm of back.
Headache and Related Codes
Many patients seek chiropractic care for headaches.
- R51: Headache.
- G43.909: Migraine, unspecified, not intractable, without status migrainosus.
- G44.209: Tension-type headache, unspecified, not intractable.
The Importance of Linking CPT and ICD-10 Codes: Chiropractic Billing Cheat Sheet
Submitting a claim is not as simple as listing services and diagnoses. You must link each CPT code (service) to the ICD-10 code (diagnosis) that justifies it. This connection demonstrates medical necessity. It tells the insurance company why a particular treatment was necessary for a specific condition.
For example, if you bill CPT code 98940 (CMT, 1-2 regions), you must link it to a diagnosis like M99.01 (cervical dysfunction) or M54.2 (cervicalgia). This shows that the adjustment was performed to treat the patient’s neck issue. A mismatch, like linking a knee adjustment to a neck pain diagnosis, would result in an immediate denial. See Medical Billing Codes, CPT, Modifiers and Compliance for Chiropractors
Tips for Avoiding Common Chiropractic Billing Errors
Clean claims get paid faster. Here are a few tips to improve your billing accuracy and avoid common pitfalls.
Stay Updated on Code Changes
Both CPT and ICD-10 codes are updated every year. Using a deleted or outdated code is a guaranteed way to get a claim denied. Make it a priority for your staff to review the annual updates. The official CMS ICD-10 code sets are published online, providing a reliable source for the latest information.
Use Modifiers Correctly
Modifiers are two-digit codes added to a CPT code to provide more information about a service. Two common modifiers in chiropractic care are -25 and -59. Modifier -25 is used when a significant, separately identifiable E/M service is performed on the same day as a procedure like a CMT. Modifier -59 indicates that a procedure was distinct or independent from other services performed on the same day. Improper use of modifiers is a major red flag for auditors.
Document Everything Thoroughly
Your clinical documentation is your ultimate proof of medical necessity. Notes should be clear, concise, and complete. They must support the CPT and ICD-10 codes you bill. Good documentation includes the patient’s history, examination findings, diagnosis, treatment plan, and the patient’s response to care. In an audit, if it is not written down, it did not happen.
Verify Insurance Benefits Before Treatment
Never assume a patient’s coverage. Always verify insurance benefits before the first visit. Check for details like co-pays, deductibles, visit limits, and whether prior authorization is required for certain services. This simple step can prevent many billing headaches and unhappy patients down the road.
Frequently Asked Questions
What is the difference between a CPT code and an ICD-10 code?
A CPT code describes the service you performed, like a spinal adjustment or therapeutic exercise. An ICD-10 code is the diagnosis that explains why you performed the service, such as low back pain or cervical dysfunction.
How many regions are covered by CPT code 98941?
CPT code 98941 covers Chiropractic Manipulative Treatment (CMT) for three to four spinal regions. The spinal regions are cervical, thoracic, lumbar, sacral, and pelvic.
Can I bill an E/M code with a CMT code on the same day?
Yes, but only if the evaluation service was significant and separately identifiable from the adjustment. You must append Modifier -25 to the E/M code. Your documentation must clearly support the need for both services.
Why is specificity so important with ICD-10 codes?
Specificity proves medical necessity. A more specific code, like M54.5 (Low back pain) instead of a general back pain code, gives the insurance company a clearer picture of the patient’s condition and why your treatment is appropriate.
What happens if I use an outdated code?
If you use an outdated or deleted code, the insurance claim will be denied. Payers process claims using the current year’s code sets, so using old codes results in an automatic rejection, delaying your payment.
