CPT 98943 describes chiropractic manipulative treatment (CMT) of one or more extraspinal regions. CPT recognizes five extraspinal regions for this code: the head (including the temporomandibular joint), the lower extremities, the upper extremities, the rib cage (excluding costotransverse and costovertebral joints), and the abdomen. Unlike the spinal CMT codes 98940–98942, which scale by the number of spinal regions treated, 98943 is reported once regardless of how many extraspinal regions are adjusted in the encounter.
Report 98943 when the chiropractor performs manipulative treatment on one or more of the five extraspinal regions and the documentation supports a diagnosis and treatment plan for that region — for example an extremity adjustment for a shoulder or ankle dysfunction, or TMJ manipulation. It may be reported on the same day as a spinal CMT code (98940–98942) when both spinal and extraspinal regions are treated, since the code families describe anatomically distinct work; some payers require a modifier such as 51 or 59 on the claim to process the combination, so follow each payer’s published instruction.
Do not bill 98943 to Medicare expecting payment: Medicare’s chiropractic benefit is limited by statute to manual manipulation of the spine to correct a subluxation, so extraspinal CMT is statutorily excluded — it may be billed to obtain a denial for secondary insurance, but it is never a covered Medicare service. Do not report multiple units of 98943 for multiple extraspinal regions; the descriptor is "one or more regions." Do not use it for manipulation of costovertebral or costotransverse joints, which count as the thoracic spinal region. And do not report it when the record documents only spinal treatment — the extraspinal region needs its own findings and diagnosis.
The note should identify which extraspinal region(s) were treated, the examination findings and diagnosis specific to that region, the manipulation technique used, and the treatment goal within a plan of care. Because payers scrutinize same-day spinal-plus-extraspinal billing, the extraspinal problem must stand on its own in the record — a distinct diagnosis code pointing to the 98943 line, not the same spinal subluxation diagnosis reused.
No. The Medicare chiropractic benefit covers only manual manipulation of the spine to correct a subluxation (98940–98942 with the AT modifier). Extraspinal manipulation is statutorily excluded, so 98943 is billed to Medicare only to generate a denial for a secondary payer, typically with modifier GY.
Yes, when both spinal and extraspinal regions are genuinely treated and separately documented. Commercial payer processing rules vary — some want modifier 51 or 59 on the combination — so check the specific payer policy rather than assuming one convention.
No. The descriptor reads "one or more regions," so a single unit covers all extraspinal regions treated in the encounter, whether that is one or all five.
CPT defines five: head (including TMJ), lower extremities, upper extremities, rib cage excluding the costotransverse and costovertebral joints, and abdomen. Costovertebral/costotransverse work belongs to the thoracic spinal region under 98940–98942 instead.
Coding questions like this one are where revenue leaks start. See how Medtransic supports chiropractic practices with certified billing and denial management: Chiropractic Billing Services.