How much does Medicare pay for CPT 98942?

Medicare allowed an average of $49.84 per service and paid $36.27 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $73.85, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 98942?

Chiropractic manipulative treatment, 5 spinal regions. It was billed 883,182 times to 93,554 Medicare beneficiaries by 2,539 providers in 2024.

Does 98942 pay differently in an office than a hospital?

Yes. The allowed amount averaged $49.88 in an office setting and $46.84 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 98942 most?

Chiropractic, with 883,182 services from 2,539 clinicians.

CPT 98942

Chiropractic manipulative treatment, 5 spinal regions

$49.84Medicare-allowed amount per service, averaged across 883,182 services

Providers submitted

$73.85

Asking price, not received

Medicare allowed

$49.84

The fee schedule figure

Medicare paid

$36.27

Balance is patient coinsurance

Providers submitted an average of $73.85 for this code and Medicare allowed $49.84 — 1.5× 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 $36.27 (73%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $49.88
Hospital / facility: $46.84

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. 872,246 services were billed in an office setting and 10,936 in a facility.

Services: 883,182
Beneficiaries: 93,554
Providers billing it: 2,539
Total allowed: $44,017,791

What Medicare pays for CPT 98942

Across 883,182 services billed by 2,539 providers to 93,554 beneficiaries, Medicare allowed an average of $49.84 per service. That is 9.4 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 98942

Specialty	Services	Beneficiaries	Avg allowed	Providers
Chiropractic	883,182	93,554	$49.84	2,539

98942 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
California	169,796	$53.52	$37.14	307
New Jersey	73,787	$53.09	$36.72	207
Texas	67,539	$48.00	$36.27	192
Michigan	58,403	$48.61	$35.48	252
Florida	41,885	$48.74	$35.99	124
Pennsylvania	38,199	$48.96	$36.26	118
Virginia	34,854	$48.97	$36.01	72
Arizona	33,596	$48.77	$36.06	77
Washington	22,519	$50.50	$35.87	81
Illinois	19,439	$47.19	$35.88	50
Ohio	19,321	$47.97	$35.57	56
Georgia	19,262	$48.54	$35.92	58
Arkansas	18,813	$46.38	$36.17	40
Maryland	17,063	$51.66	$36.44	41
Alabama	16,049	$45.82	$35.33	57
New York	15,797	$50.74	$36.09	37
Massachusetts	14,963	$51.65	$36.39	53
South Carolina	14,340	$47.62	$35.79	52
Kansas	13,993	$46.98	$36.06	41
Tennessee	12,976	$47.09	$36.05	33
New Mexico	11,907	$46.59	$35.34	30
North Carolina	11,048	$46.23	$36.02	35
Idaho	10,826	$47.14	$35.15	38
Missouri	10,264	$47.56	$36.01	41
Iowa	9,624	$47.79	$35.39	44
Colorado	9,184	$50.15	$35.53	36
New Hampshire	8,989	$49.11	$35.66	27
Oklahoma	8,725	$47.05	$35.94	19
Utah	7,503	$48.21	$36.02	28
Nevada	6,044	$49.40	$36.62	10
Vermont	5,702	$49.11	$34.47	22
Nebraska	5,702	$46.59	$35.22	24
Delaware	5,146	$49.70	$35.40	16
Wisconsin	5,143	$48.09	$35.88	28
Indiana	5,060	$44.82	$36.46	17
Montana	4,287	$50.42	$34.77	28
Oregon	3,929	$48.71	$35.02	20
Connecticut	3,603	$48.98	$38.16	5
Hawaii	3,129	$49.69	$34.90	5
West Virginia	2,925	$45.43	$36.18	8
Rhode Island	2,897	$49.61	$36.62	7
South Dakota	2,820	$49.20	$33.85	22
Alaska	2,507	$65.53	$34.67	15
Minnesota	2,443	$48.88	$36.42	13
Maine	2,241	$48.55	$36.26	13
Louisiana	2,084	$46.63	$36.94	9
Mississippi	1,994	$46.13	$36.08	7
Puerto Rico	1,820	$49.61	$35.94	11
Kentucky	1,175	$45.15	$35.75	6
U.S. Virgin Islands	702	$49.32	$37.60	2
North Dakota	476	$49.61	$35.07	2
Wyoming	465	$50.16	$35.44	2
Guam	224	$49.77	$30.88	1

Related codes

98941Chiropractic manipulative treatment$38.12
98940Chiropractic manipulative treatment$26.75
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.