In today’s fast-evolving healthcare landscape, chiropractic CPT codes play a critical role in optimizing reimbursement, ensuring compliance, and streamlining documentation. As chiropractors and billing teams navigate the latest CPT updates for 2025, understanding how to correctly apply these codes can mean the difference between clean claims and costly denials.
Whether you’re a solo practitioner or part of a larger practice, this guide will walk you through the most common chiropractic CPT codes, changes to look out for in 2025, coding scenarios, and how to stay compliant, all aligned with current industry standards from the AMA and CMS.
Why Chiropractic CPT Codes Matter in 2025
CPT (Current Procedural Terminology) codes are standardized identifiers used to describe medical, surgical, and diagnostic services. For chiropractic practices, accurate use of chiropractic billing codes is essential for insurance reimbursement and maintaining regulatory compliance. You can also consider medical coding outsourcing services to save time and ensure accuracy.
According to the American Chiropractic Association (ACA), errors in chiropractic codes can result in a 20% reduction in reimbursement, often due to improper modifier use or misaligned documentation. This makes training, awareness, and software automation more critical than ever.
Most Common Chiropractic CPT Codes
Here are the common chiropractic CPT codes you’ll likely use in 2025, based on trends and insurance utilization data:
- 98940: Chiropractic manipulative treatment (CMT); 1-2 regions
- 98941: CMT; 3-4 regions
- 98942: CMT; 5 regions
- 98943: Extraspinal CMT (e.g., arms, legs, ribs, jaw)
- 97035: Ultrasound therapy
- 97110: Therapeutic exercise, one-on-one
- 97140: Manual therapy (e.g., myofascial release, trigger point)
These CPT codes for chiropractic care cover the majority of services rendered; however, understanding when and how to use them is equally important. We also have a pain management CPT codes cheat sheet, which you would like to access.
Real-World Example: Avoiding Reimbursement Delays
Take the case of Dr. Patel, a chiropractor in Austin, TX, who saw denials for CPT 98942. On audit, it was found that although five spinal regions were adjusted, documentation only supported four. Insurers denied claims based on insufficient clinical justification.
This is a common pitfall. Overusing or misapplying chiropractor CPT code options, without matching chart notes, triggers audits and revenue loss.
Tip: Always ensure the number of spinal regions adjusted is clearly documented in SOAP notes. When in doubt, err on the side of coding conservatively.
Updates and Changes in 2025
As of the 2025 CPT code release:
- No new CPT codes were introduced for chiropractic adjustments; however, there are clarifications on modifier 25 usage, particularly when E/M services are billed on the same day as a CMT.
- Payers, such as Medicare, have updated their interpretation of manual therapy codes (97140) when billed in conjunction with CMT, requiring the use of modifier 59 and strong documentation to support distinct services.
- The CMS has also tightened auditing around medical necessity. Using ICD-10 codes, such as M99.01–M99.05, must align with the spinal regions billed via CPT.
Reminder: Not all plans reimburse for therapeutic modalities (e.g., ultrasound). Always verify coverage for each payer.
Chiropractic CPT Modifiers You Should Know
Modifiers can make or break a claim. Here are the most relevant ones in chiropractic billing:
- 25: Significant, separately identifiable E/M service by the same provider on the same day as a procedure
- 59: Distinct procedural service (used when billing manual therapy with spinal adjustments)
- GA/GY/GZ: For Medicare ABN (Advance Beneficiary Notice) compliance
Incorrect use of modifiers can result in payment retractions. If your practice is using outdated templates or EHR automation that automatically adds modifiers, it’s time for a review.
Best Practices for Chiropractic Code Accuracy
To stay ahead in 2025:
- Train your billing staff quarterly on payer-specific rules. CPT codes don’t change often, but insurer policies do.
- Audit your most-used codes every 60–90 days. Internal audits catch documentation gaps before payers do.
- Utilize integrated EHR systems that directly link documentation to CPT code selection. This prevents misalignment.
- Avoid upcoding, especially in CMT codes. Reimbursement might be higher in the short term, but payers are investing in AI audit tools.
Compliance Reminders from HFMA and CMS
- Ensure your documentation clearly supports medical necessity. CMS emphasizes that spinal manipulation must have a diagnosable subluxation.
- When using chiropractic CPT codes for therapeutic modalities, document the time spent per session. For timed codes like 97110, every 15-minute increment must be justified.
- Regularly review OIG (Office of Inspector General) work plans for chiropractic services. These audits often cite excessive billing of 98941 and 98942.
Bridging the Gap with Chiropractic Billing Software
While the reviewed blogs explain the basics, they overlook critical strategy angles, such as payer-specific coding policies or how RCM partners can enhance claim performance. At AffinityCore, we help clients decipher the complexities behind chiropractic billing codes with intelligent systems, real-time denial analytics, and streamlined claim strategies.
Our team doesn’t just code — we understand your revenue cycle from the ground up.
Why Choose AffinityCore for Chiropractic Revenue Cycle Optimization
At AffinityCore, we partner with chiropractors to enhance their financial performance through accurate coding, payer-specific insights, and seamless integration with Electronic Health Record (EHR) platforms. Whether you’re navigating chiropractic codes for the first time or trying to reduce denials, we bring clarity and consistency to your revenue cycle management (RCM).
We’ve helped practices reduce claim denials by 32% and increase monthly collections within 90 days of engagement.
Let’s simplify your coding — and your revenue cycle.
Need help navigating CPT changes or optimizing your chiropractic billing process?
Let’s talk. Visit AffinityCore’s Medical Coding and Billing Services to learn how we support practices like yours.
Frequently Asked Questions
What are the most common Chiropractic CPT Codes for 2025?
The most frequently used codes remain the Chiropractic Manipulative Treatment (CMT) codes 98940–98942 (spinal regions 1–3) and the Evaluation & Management codes 99202–99215 (new and established patient visits).
How are CMT codes billed in 2025?
CMT codes 98940–98943 are billed based on the number of spinal regions treated (e.g. 98940 covers 1–2 regions). Always append the AT modifier for active/corrective treatment to meet Medicare documentation rules.
Which modifiers apply to Chiropractic CPT codes in 2025?
- AT: Required for active treatment of subluxation (Medicare).
- 25: Use with E/M codes (99202–99215) when performed on the same day as CMT.
- QA: Reporting modifier for certain state Medicaid programs.
How do Evaluation & Management (E/M) codes work for chiropractors in 2025?
Chiropractors use 99202–99205 for new patient visits (15–60 min) and 99211–99215 for established patient visits. Selection is based on the total time or the complexity of medical decision-making documented in the record.
Where can I find the official 2025 CPT code updates for chiropractic services?
The American Medical Association publishes the annual CPT code set each October. The 2025 release includes 270 new codes, 112 deletions, and 38 revisions, all of which are available on the AMA website.
