How much does Medicare pay for CPT 98940?

Medicare allowed an average of $26.75 per service and paid $18.64 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $48.59, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 98940?

Chiropractic manipulative treatment, 1-2 spinal regions. It was billed 3,370,055 times to 467,330 Medicare beneficiaries by 11,909 providers in 2024.

Does 98940 pay differently in an office than a hospital?

Yes. The allowed amount averaged $26.76 in an office setting and $22.79 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 98940 most?

Chiropractic, with 3,366,491 services from 11,901 clinicians. Next are Physical Therapist in Private Practice, Nurse Practitioner.

CPT 98940

Chiropractic manipulative treatment, 1-2 spinal regions

$26.75Medicare-allowed amount per service, averaged across 3,370,055 services

Providers submitted

$48.59

Asking price, not received

Medicare allowed

$26.75

The fee schedule figure

Medicare paid

$18.64

Balance is patient coinsurance

Providers submitted an average of $48.59 for this code and Medicare allowed $26.75 — 1.8× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $18.64 (70%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $26.76
Hospital / facility: $22.79

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 3,363,234 services were billed in an office setting and 6,821 in a facility.

Services: 3,370,055
Beneficiaries: 467,330
Providers billing it: 11,909
Total allowed: $90,148,971

What Medicare pays for CPT 98940

Across 3,370,055 services billed by 11,909 providers to 467,330 beneficiaries, Medicare allowed an average of $26.75 per service. That is 7.2 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 98940

Specialty	Services	Beneficiaries	Avg allowed	Providers
Chiropractic	3,366,491	467,007	$26.75	11,901
Physical Therapist in Private Practice	2,926	181	$29.68	5
Nurse Practitioner	638	142	$26.29	3

98940 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
New York	576,281	$28.53	$19.53	1,098
California	254,312	$28.67	$18.95	843
Illinois	167,894	$26.22	$18.86	547
Florida	165,902	$26.39	$18.67	706
Wisconsin	143,449	$25.83	$18.24	576
Ohio	127,678	$25.47	$18.27	516
Pennsylvania	121,540	$26.21	$18.72	522
Iowa	119,055	$25.49	$18.22	451
Arizona	87,364	$26.22	$18.46	247
Minnesota	84,892	$26.49	$18.30	422
New Jersey	83,478	$28.93	$19.78	329
Texas	81,571	$25.96	$18.67	356
Virginia	73,306	$26.51	$18.67	240
Kansas	70,348	$25.50	$18.57	220
Kentucky	68,624	$25.04	$18.70	245
Connecticut	67,207	$27.85	$19.15	206
Oklahoma	66,103	$25.01	$18.60	146
Washington	65,525	$27.13	$18.30	286
Missouri	65,221	$25.25	$18.58	267
Massachusetts	64,068	$28.13	$18.99	213
Nebraska	57,905	$25.46	$18.51	224
Tennessee	57,049	$25.14	$18.64	184
North Carolina	54,843	$25.61	$18.69	278
North Dakota	53,876	$26.30	$17.64	201
South Carolina	50,788	$25.42	$18.86	166
Georgia	49,911	$25.65	$18.66	210
Indiana	48,804	$25.37	$18.35	206
Michigan	44,843	$26.03	$18.23	233
Maryland	42,150	$27.74	$18.90	142
Colorado	39,793	$27.05	$18.40	187
Arkansas	34,202	$24.98	$18.47	109
South Dakota	29,743	$26.32	$17.91	163
Louisiana	28,486	$25.08	$18.70	113
Oregon	27,557	$26.06	$18.17	159
Alabama	24,116	$24.57	$18.43	111
Montana	23,949	$26.48	$17.75	107
Wyoming	21,449	$25.91	$18.00	59
Mississippi	20,959	$24.41	$19.07	79
Nevada	15,132	$26.40	$18.38	53
West Virginia	12,856	$25.16	$18.42	61
Alaska	11,037	$34.39	$18.04	73
New Hampshire	10,090	$26.98	$18.21	45
Utah	10,009	$25.67	$18.69	50
Maine	9,598	$26.29	$18.35	55
Rhode Island	8,420	$27.10	$18.84	29
Idaho	8,019	$25.33	$17.73	56
Delaware	6,254	$26.64	$19.30	34
New Mexico	4,948	$25.47	$18.63	30
Vermont	3,984	$26.38	$18.08	26
Hawaii	3,708	$27.82	$18.30	19
Puerto Rico	799	$26.61	$18.91	5
District of Columbia	534	$28.89	$19.51	3
U.S. Virgin Islands	276	$26.56	$18.54	2
XX	150	$25.18	$16.33	1

Related codes

98941Chiropractic manipulative treatment$38.12
98942Chiropractic manipulative treatment$49.84
98977Device supply$48.07
98976Device supply$48.79
98980Remote therapeutic monitoring treatment management services by physici$49.72
98929Osteopathic manipulative treatment$83.31
98928Osteopathic manipulative treatment$70.48
98926Osteopathic manipulative treatment$43.00
98927Osteopathic manipulative treatment$57.47
98981Remote therapeutic monitoring treatment management services by physici$38.72
98975Set-up and patient education for remote monitoring of therapy$20.19
98925Osteopathic manipulative treatment$30.48

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.