CPT (Current Procedural Terminology) codes are five-digit numbers that describe every medical service or procedure. Your doctor, hospital, and insurance company use them to communicate exactly what was done. Every line on your medical bill has a CPT code, and knowing the code lets you look up what Medicare pays for that same service.

Why do providers charge so much more than Medicare pays?

Providers set their own "chargemaster" prices, which are essentially list prices. Medicare pays a fixed rate based on the resources each service actually requires (the RVU system for procedures, or the Clinical Lab Fee Schedule for lab tests). Commercial insurers typically pay 150% to 250% of Medicare rates. Uninsured patients are often billed the full chargemaster price, which can be 2x to 30x what Medicare pays.

Can I use Medicare rates to negotiate my bill?

Yes. Medicare rates are the closest thing to a "fair price" benchmark in U.S. healthcare. When negotiating, ask the provider what they accept from Medicare for the same CPT code. Most providers will accept 150% to 200% of Medicare for cash-pay patients, which is still far less than their chargemaster price. Many hospital financial assistance policies also use a multiple of Medicare as their discount floor.

How are Medicare rates calculated?

For most procedures, Medicare uses the Resource-Based Relative Value Scale (RBRVS). Each CPT code gets three RVU components: Work (physician time and skill), Practice Expense (overhead), and Malpractice. These are multiplied by geographic adjustment factors (GPCIs) and a conversion factor ($33.4009 in 2026). Lab tests (80000-89999 range) use a separate Clinical Laboratory Fee Schedule with flat national rates.

CPT 98941

Chiropractic Manipulative Treatment, 3-4 Spinal Regions

CPT 98941 is the most common chiropractic manipulation code, covering manual treatment of 3 to 4 spinal regions. Providers charge an average of $59.73, while Medicare pays $38.41 (1.6x markup). The per-visit cost seems modest, but the real expense is frequency: chiropractors often recommend 2 to 3 visits per week, which adds up to $480 to $720 per month at typical rates.

Updated May 2026Source: CMS Physician Fee Schedule

CPT 98941 at a Glance

Average provider charge: $59.73
Medicare rate (office): $38.41
Medicare rate (facility): $38.41
Typical markup: 1.6x over Medicare rate

Spinal regions treated: 3 to 4
Procedure type: Manual manipulation
Medicare beneficiaries (2023): 1.28 million
Monthly cost at 2x/week: ~$480

How the Medicare Rate Is Calculated

Medicare values every procedure using Relative Value Units (RVUs) across three components, then multiplies by a national conversion factor of $33.4009 (2026). Here is the exact math for a 98941 chiropractic manipulation:

Component	What It Covers	Office (Non-Facility)	Hospital (Facility)
Work RVU	Physician time, skill, and judgment	0.60	0.60
Practice Expense RVU	Rent, staff, equipment, supplies	0.41	0.41
Malpractice RVU	Professional liability insurance	0.14	0.14
Total RVU		1.15	1.15
x $33.4009	2026 conversion factor	$38.41	$38.41

Why office and facility rates are the same: Unlike most procedures, chiropractic manipulation has identical RVUs in both settings. This is because the practice expense is the same regardless of where it is performed. Chiropractors almost always practice in office settings, not hospitals.

Medicare Rate by State

Medicare adjusts the national rate based on your location using Geographic Practice Cost Indices (GPCIs). The same 98941 manipulation pays differently by state, ranging from about $30 in Arkansas to $37 in Alaska.

Medicare Rate by State (2026)

Medicare adjusts payments by location using Geographic Practice Cost Indices (GPCIs). Select your state to see the adjusted rate.

Sample State Rates (Office Setting)

State	Medicare Pays	Avg. Charge	Markup
Texas (Austin)	$32.64	$59.73	1.8x
California (Los Angeles)	$33.69	$59.73	1.8x
New York (Manhattan)	$34.28	$59.73	1.7x
Florida (Fort Lauderdale)	$32.55	$59.73	1.8x
Ohio	$31.17	$59.73	1.9x
Mississippi	$30.25	$59.73	2.0x
Arkansas	$30.14	$59.73	2.0x
Alaska	$36.53	$59.73	1.6x

Rates shown are for the non-facility (office) setting using 2026 GPCIs and the $33.4009 conversion factor. The average provider charge of $59.73 is the 2023 national average from CMS utilization data. Actual charges vary by provider.

What Insured Patients Actually Pay for Chiropractic

If you have health insurance, your cost per visit depends on your plan design. But the bigger picture is total monthly cost: at 2 to 3 visits per week, even modest copays add up quickly.

Your Situation	Per Visit Cost	Monthly Cost (8 visits)
Copay plan (deductible met)	$20 to $50	$160 to $400
Coinsurance plan (deductible met)	$8 to $14	$64 to $112
High-deductible plan (not met)	$40 to $70	$320 to $560
Medicare Part B	$7.68	$61.44
Cash pay (no insurance)	$40 to $70	$320 to $560

Watch for visit caps. Most commercial plans limit chiropractic visits to 20 to 30 per year. At 2 visits per week, you hit 30 visits in just 15 weeks. After that, you pay the full charge out of pocket. Ask your insurer for your annual visit limit before starting a treatment plan.

Should You Use Insurance or Pay Cash for Chiropractic?

Because chiropractic visits are relatively inexpensive per visit but high frequency, the insurance vs. cash decision depends heavily on your visit limit and copay structure.

When Cash-Pay Wins

Your copay is higher than the cash-pay rate (some providers charge $35 to $45 for cash patients)
You have already hit your plan's annual visit cap
Package deals: many chiropractors offer prepaid packages of 10 to 12 visits at 20 to 30% off
You want to avoid the visit counting toward your plan's annual limit

When Using Insurance Wins

Your copay is $20 to $30, below typical cash rates
You have not yet reached your annual visit cap
You are close to meeting your annual deductible
Your plan has no chiropractic visit limit (rare but some do)

The frequency trap: A chiropractor who recommends 3 visits per week indefinitely is creating a $720/month expense at $60/visit (or $360/month at your copay of $45). Ask for a written treatment plan with a defined endpoint. Evidence-based guidelines suggest most acute back pain improves within 4 to 6 weeks of care, not 6 to 12 months.

Common Billing Problems with 98941

Separate office visit billed on top of the manipulation

Some chiropractors bill a 99213 or 99214 office visit ($95 to $136) in addition to the 98941 manipulation on every visit. This is only appropriate when a separately identifiable evaluation is performed (new complaint, new exam findings, changed treatment plan). If every visit includes both codes and your treatment plan has not changed, question the E/M charge. Note: Medicare does not cover chiropractic E/M codes at all.

Maintenance care billed to Medicare

Medicare covers chiropractic manipulation only when it is expected to result in improvement. Once you have reached maximum therapeutic benefit, continued visits are classified as "maintenance care" and are not covered. If your chiropractor continues billing Medicare after your condition has plateaued, you may receive a denial or be asked to repay. An Advance Beneficiary Notice (ABN) should be given before maintenance care begins.

Billing for regions not treated

CPT 98941 covers 3 to 4 spinal regions. The lower code, 98940 (1-2 regions), pays $28.31. If your chiropractor only adjusts your lower back (one region), the correct code is 98940, not 98941. Upcoding from 98940 to 98941 is a common pattern because the documentation is often vague about which specific regions were manipulated. Your visit notes should specify which spinal regions were treated.

Bundled services billed separately

Some chiropractors bill additional codes for therapies that should be included in the manipulation (such as hot/cold packs, manual therapy, or therapeutic exercises). While these can be separately billable in some cases, CMS has specific rules about which services are bundled into the manipulation code. If your bill includes 3 to 5 separate line items per visit on top of 98941, review whether each service was truly distinct and medically necessary.

Related Chiropractic and Manipulation Codes

Code	Description	Regions	Medicare Rate	Avg. Charge
98940	Chiropractic manipulation	1-2	$28.31	$44.18
98941	Chiropractic manipulation	3-4	$38.41	$59.73
98942	Chiropractic manipulation	5	$46.46	$72.25
97140	Manual therapy (soft tissue mobilization)	N/A	$30.56	$56.78
97110	Therapeutic exercises	N/A	$33.79	$58.12

Frequently Asked Questions

How much does a chiropractic adjustment cost without insurance?

A chiropractic spinal manipulation (CPT 98941, 3-4 regions) costs $40 to $100 per visit without insurance, with a national average charge of $59.73. Many chiropractors offer package pricing or monthly memberships ($150 to $300/month for unlimited visits) that can reduce the per-visit cost significantly if you plan to go frequently.

Does Medicare cover chiropractic adjustments?

Medicare covers chiropractic manipulation only for manual manipulation of subluxation of the spine. It does not cover maintenance care (treatment not expected to improve your condition), extremity adjustments, X-rays ordered by chiropractors, exams, or other supplemental therapies. Medicare patients pay 20% coinsurance ($7.68 per visit for 98941) after meeting the Part B deductible.

How many chiropractic visits does insurance cover per year?

Most commercial insurance plans limit chiropractic visits to 20 to 30 per year. Some plans set a dollar cap instead (for example, $1,500/year in chiropractic benefits). Medicare does not set a hard visit cap but requires that each visit be medically necessary and expected to produce improvement. Once you reach maximum improvement, continued visits are classified as maintenance and are denied.

Can a chiropractor bill an office visit on top of the adjustment?

Yes. Chiropractors may bill a separate evaluation and management code (99213 or 99214) on the same day as the manipulation if a distinct, separately identifiable evaluation was performed. However, this should not happen at every routine visit. Medicare does not cover chiropractic E/M services at all, so Medicare patients cannot be billed for them. For commercial plans, the added E/M code increases your total cost by $95 to $135 per visit.

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