CPT 98942 Fee Schedule
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.
| 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 | • None • AT - Acute or Active Treatment • GA - Required ABN issued and on file |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 98942 |
National average reimbursement for CPT 98942 by major payers:
$46.43
$57.80
$46.16
$71.62
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 98942 | ||||||
United | 98942 | $52.96 | 1073530523 - DAVID KIM | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Interventional Pain Medicine Physician (208VP0014X) |
United | 98942 | $89.47 | 1578531950 - DAVID RITACCO | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 98942 | $42.42 | 1801543756 - KRISTIN WHITLEY | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Adult Health Nurse Practitioner (363LA2200X) |
United | 98942 | $55.16 | 1225211600 - JOHN MILLICHAP | 262037695 - GRADY MEMORIAL HOSPITAL CORPORATION | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 98942 | $134.69 | 1568752665 - ANDREW KNOX | 391678306 - AURORA MEDICAL GROUP INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 98942 | $67.00 | 1760461867 - RITA YADAVA | 363878197 - (IL) RITA YADAVA MDSC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 98942 | $52.96 | 1033587365 - GABRIELLE PHAM-CHE | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Orthopedic Physical Therapist (2251X0800X) |
United | 98942 | $50.09 | 1760412621 - RHONDA LAMPEN | 911352172 - MULTICARE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 98942 | $51.77 | 1336431667 - SURAYA KAWADRY | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 98942 | $43.60 | 1013534106 - NATALIA CASTRO | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Family Nurse Practitioner (363LF0000X) |
United | 98942 | $87.55 | 1790181402 - SONAM VERMA | 611661781 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 98942 | $54.90 | 1861488132 - JYOTI WARIKOO | 363305449 - (IL) MOUNT SINAI COMMUNITY FOUNDATION | IL | Psychiatry Physician (2084P0800X) |
United | 98942 | $52.96 | 1457365637 - CHARLES SEAL | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Orthopaedic Surgery Physician (207X00000X) |
United | 98942 | $44.65 | 1578767935 - FABIAN CARBONELL MD SC | 364336222 - (IL) FABIAN CARBONELL MD SC | IL | Psychiatry Physician (2084P0800X) |
United | 98942 | $89.15 | 1700895257 - LARA SEGALITE | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 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 |
|---|---|---|
| 98927-CPT | Low | Osteopathic Manipulative Treatment 5,6 Body Regions |
| 98928-CPT | Low | Osteopathic Manipulative Treatment 7, 8 Body Regions |
| 98940-CPT | Low | Chiropractic Manipulative Treatment (Cmt); Spinal, One To Two Regions |
| 98942-CPT | Low | Chiropractic Manipulative Treatment (Cmt); Spinal, Five Regions |
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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