Medicare reimburses chiropractic adjustments based on the Medicare Physician Fee Schedule (MPFS), which sets allowed amounts for each CPT code by geographic locality. The rates change annually, and your actual payment depends on the code billed, your location, and whether you are a participating or non-participating provider.
2026 Medicare Reimbursement Rates
The following are approximate national average Medicare allowed amounts for chiropractic manipulative treatment codes in 2026. Your actual rates will vary based on your MAC locality.
| CPT Code | Regions | Medicare Allowed (Approx.) | Medicare Pays (80%) | Patient Pays (20%) |
|---|---|---|---|---|
| 98940 | 1-2 spinal | $28–$35 | $22–$28 | $6–$7 |
| 98941 | 3-4 spinal | $48–$58 | $38–$46 | $10–$12 |
| 98942 | 5 spinal | $62–$75 | $50–$60 | $12–$15 |
These rates are after the annual Part B deductible has been met. In 2026, the Part B deductible is $257. Until the patient meets this deductible, they pay 100% of the allowed amount.
Participating vs. Non-Participating Providers
Participating Providers
If you accept Medicare assignment (participating provider), you agree to accept the Medicare allowed amount as full payment. Medicare pays its 80% share directly to you, and the patient owes the 20% coinsurance. You cannot bill the patient anything above the allowed amount.
Non-Participating Providers
Non-participating providers who do not accept assignment can charge up to 115% of the Medicare allowed amount (the limiting charge). The patient pays the full amount upfront and submits to Medicare for reimbursement. Medicare pays the patient 80% of the non-participating fee schedule (which is 95% of the participating rate).
In practice, most chiropractic practices that see Medicare patients find it simpler and better for patient retention to participate and accept assignment.
What Affects Your Specific Rate
- Geographic locality — Medicare adjusts rates by the Geographic Practice Cost Index (GPCI). Urban areas with higher costs of living have higher allowed amounts than rural areas. The difference can be 20-30% between the highest and lowest localities.
- Facility vs. non-facility — Chiropractic services are almost always performed in non-facility settings (your office), which has a higher payment rate than facility settings.
- Annual MPFS updates — CMS updates the fee schedule each January. The conversion factor and relative value units (RVUs) can change, affecting your rates year to year.
How to find your exact rates: Search the CMS Physician Fee Schedule Lookup Tool at cms.gov. Enter your MAC locality, the CPT code, and select the current year. This gives you the precise allowed amount for your area.
Why Medicare Pays Less Than Commercial Payers
Medicare reimbursement for chiropractic is significantly lower than most commercial insurance rates. While Medicare might allow $50 for a 98941, a commercial payer in the same market might allow $65–$90 for the same code. This gap matters for practices that are heavily Medicare-dependent.
Some strategies to manage this include maintaining a balanced payer mix rather than becoming overly dependent on Medicare patients, billing non-covered services (with proper ABN) directly to patients at your standard rates, and offering cash-pay packages for maintenance care once patients transition off active Medicare-covered treatment.
When Medicare Doesn't Pay
Medicare will pay $0 for chiropractic visits that are denied for any of the following reasons:
- Missing AT modifier on the claim
- Treatment classified as maintenance care rather than active treatment
- Insufficient subluxation documentation
- Services other than spinal CMT (X-rays, E/M visits, modalities)
- Claim submitted after the timely filing deadline
Denied claims cannot be billed to the patient unless an ABN was obtained before the service was rendered.
Know your reimbursement rates and compliance obligations
ChiropractorBillingClarity tracks Medicare fee schedule changes, LCD updates, and billing policy shifts every month — so you don't have to.
Subscribe — $247/month →The Bottom Line
Medicare chiropractic reimbursement is modest but predictable. Knowing your exact local rates helps you set realistic financial expectations, price your self-pay services competitively, and identify when your payer mix has become too heavily weighted toward Medicare. The most financially healthy chiropractic practices treat Medicare patients as part of a diversified payer base — not as the foundation of their revenue model.