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See a sample rate comparisonCPT 98942 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Chiropractic Adjustment, Chiropractic Services To Treat One To Five Areas Of The Spine. The Areas Are Moved Gently To Encourage The Body To Realign Itself.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Chiropractic Manipulative Treatment Procedures |
| Common Place of Service | 11 - Office 50 - Federally Qualified Health Center |
| Common Modifiers | AT - Acute or Active Treatment GA - Required ABN issued and on file |
| Complexity Level | Low |
| Medicare Fee Schedule | $49.77 national non-facility rate (2026) · View Medicare rates for 98942 |
| Medicaid Fee Schedule | $41.61 median of the 7 states in the free preview · View Medicaid rates for 98942 |
National average reimbursement for CPT 98942 by major payers:
$46.43
$57.80
$46.16
$69.71
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CPT 98942
5 of 25 sample ratesHigher to lower in this preview
Andrew Knox
Aurora Medical Group Inc
$134.69Published rateLekshmi Venugopal
Edward Health Ventures
$82.87Published rateJohn Millichap
Grady Memorial Hospital Corporation
$55.16Published rateJonathan Howard
Veterans Assistance Commission C
$52.52Published rateKristin Whitley
Town Center Orthopaedic Associates, P.C.
$42.42Published rate
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See a sample payer proposalCPT 98942 vs. Other Chiropractic Manipulative Treatment Procedures Codes
The CPT 98942 code is part of the Medicine Services and Procedures services used for Chiropractic Manipulative Treatment Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 98942 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 98940-CPT | Low | Chiropractic Adjustment, Chiropractic Services To Treat One To Five Areas Of The Spine. The Areas Are Moved Gently To Encourage The Body To Realign Itself. |
| 98941-CPT | Low | Chiropractic Manipulative Trea, Chiropractic Manipulative Treatment (Cmt) Spinalthree To Four Regions Chiropractic Manipulative Treatment (Cmt) Spinal Three To |
| 98942-CPT | Low | Chiropractic Adjustment, Chiropractic Services To Treat One To Five Areas Of The Spine. The Areas Are Moved Gently To Encourage The Body To Realign Itself. |
| 98943-CPT | Low | Chiropractic Manipulative Trea, Chiropractic Manipulative Treatment (Cmt) Extraspinal One Or More Regions Chiropractic Manipulative Treatment (Cmt) Extraspinal One |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 98942. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 98942 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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Frequently Asked Questions
To find the cost of a specific medical procedure, you can use a price transparency tool. Payerprice offers a fee schedule lookup tool where you can search for costs based on CPT code and your specific location. This can help you understand potential out-of-pocket expenses before your procedure.
CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services to health insurance companies. They are crucial for understanding costs because they allow you to accurately identify and look up the price for a specific service. When using tools like Payerprice, providing the correct CPT code for a procedure will give you the most accurate fee schedule information for your location.
To determine if your insurance will cover a specific service, you should directly contact your health insurance provider. They can inform you about your plan's benefits, coverage limitations, pre-authorization requirements, and your financial responsibility (deductibles, copays, coinsurance) for the service. Always verify coverage details with your insurer before receiving care.
Deductible: This is the amount of money you must pay out-of-pocket for covered healthcare services before your insurance company begins to pay. Copay (or Copayment): This is a fixed amount you pay for a covered healthcare service after you've paid your deductible (or sometimes before, depending on the service). For example, you might pay a $20 copay for a doctor's visit. Coinsurance: This is your share of the cost of a healthcare service, calculated as a percentage (e.g., 20%) of the allowed amount for the service, after you've met your deductible. If your coinsurance is 20% and the allowed amount for a service is $100, you would pay $20.
You can compare prices for medical services in your specific location using a price transparency platform like Payerprice. Their fee schedule lookup tool allows users to search with CPT codes and locations to find estimated costs, helping you make informed decisions about your healthcare.