In the not-so-easy world of chiropractic coding in the USA, few codes raise eyebrows as frequently as CPT 98941—used for chiropractic manipulative treatment (CMT) involving three to four spinal regions. It’s one of the most commonly billed codes used by chiropractors, but with that frequency comes increased scrutiny from insurance payers and Medicare.

A concerning trend: many chiropractic providers unknowingly overuse 98941, exposing their practices to audit risks and denied claims. Knowing how to tackle these challenges is important to have a successful and sustainable chiropractic practice in the USA.

Why 98941 Is Under the Microscope?

CPT code 98941 is clinically valid when three or four spinal regions are genuinely treated during a visit. However, in the landscape of chiropractic coding in the USA, data shows this code is used disproportionately more than its counterparts—98940 (1-2 regions) or 98942 (5 regions).

Why is this a problem? Payers suspect “upcoding” when a higher-level code is routinely used, especially without the thorough documentation that justifies it. For chiropractors, this pattern triggers audits, repayment demands, and even fraud investigations if the misuse is systemic.

Red Flags That Raise Payer Suspicion

Insurers and Medicare pay close attention to high utilization of 98941. Some signs that could make your use of the code a target are:

• Lack of region-specific documentation: Simply stating “spinal adjustment performed” won’t cut it. Each treated region must be clearly documented.

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• Identical notes across multiple visits: Cloned SOAP notes with no variation in treated areas or symptoms.

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• Billing 98941 on nearly every visit: Patterns matter. If 90% of your claims are for 98941, it may suggest habitual overuse.

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In the case of chiropractic coding in the USA, providers are expected to justify each code selection on a per-visit basis and not based on habit or assumption.

Documentation Tips to Support 98941

If three or four regions are legitimately adjusted, 98941 is absolutely appropriate. The key is to document thoroughly and clearly. This is what insurers want to see:

• Detailed initial and follow-up assessments that show the necessity of adjusting each region.
• Region-specific findings—such as subluxations, restricted motion, or pain levels.
• SOAP notes that evolve over time and reflect the patient’s response to treatment.

Proper documentation isn't just good practice—it's your defense in the ever-tightening world of chiropractic coding in the USA.

The Instapay Advantage

At Instapay Healthcare Services, our billing efforts are designed to help chiropractic practices navigate these challenges with smart billing strategies, ongoing coding audits, and tailored documentation coaching. Our goal? To protect your revenue while keeping you compliant with the ever-evolving landscape of chiropractic coding in the USA.

Final Thoughts

The frequent use of 98941 might be justified—but only when the documentation and clinical findings support it. In today's payer climate, even small coding missteps can have big consequences. If your practice is struggling to strike the right balance, Instapay Healthcare Services is here to help you get it right—every time.

Need a chiropractic coding review or help reducing denials? Let’s talk.