[This post was originally published on 17th May 2022. It has been updated on 17th November 2025.]
CPT 97140 is one of the most commonly used, and most frequently denied, codes in chiropractic practices. Even experienced providers struggle with when to bill it, how to document it, and how to use it alongside spinal manipulation codes without triggering payer audits. This blog breaks it down in simple terms: when to use 97140, how to document it, which modifiers matter, and how different insurers handle it.
Originally introduced in 1999, CPT 97140 replaced three separate chiropractic codes:
- 97260/97265 (Joint Mobilization)
- 97122 (Manual Traction)
- 97250 (Myofascial Release)
Despite its long history, chiropractors still face challenges getting reimbursed for 97140, especially when manual therapy and chiropractic manipulation occur in the same visit. Many wonder, “Is there any way around this 97140 denials?” The answer is yes, but it requires proper documentation, correct modifier usage, and understanding payor rules.
As chiropractic billing guidelines and payer policies continue to evolve, staying updated is critical. This guide covers exactly how to use 97140 billing code appropriately and how to determine the right circumstances for billing it so you get paid for the skilled manual therapy you provide.
What Exactly Is CPT 97140?
CPT code 97140 stands for Manual Therapy Techniques, including:
- Soft tissue mobilization
- Manual traction
- Myofascial release
- Joint mobilization (peripheral or spinal; one or more regions)
- Manual lymphatic drainage
- Manual trigger point work
It is billed in 15-minute increments, requiring one-on-one, medically necessary, skilled intervention.
97140 is not “massage.” It must be a skilled, therapeutic, medically necessary manual technique aimed at improving function, reducing restrictions, or addressing specific pathology.
97140 CPT code description
97140 CPT description says it is a timed, hands-on manual therapy code used by occupational and physical therapists for techniques such as joint mobilization, lymphatic drainage, and soft tissue manipulation to reduce pain and improve function.
When Should You Use 97140?
Use 97140 when your clinical decision-making supports manual therapy designed to:
- Reduce soft tissue adhesions
- Improve joint mobility or range of motion
- Treat trigger points
- Decrease swelling or inflammation
- Improve functional movement
- Prepare tissue for spinal manipulation
It should be supported by:
- A documented diagnosis
- A defined region of care
- Clinical necessity (pain, spasm, ROM limitation, tissue restriction, etc.)
- A measurable functional deficit
Avoid billing 97140 just because you “normally do it” before an adjustment.
That is the #1 reason for denials.
NCCI Guidelines: When You Can and Cannot Bill Physical Medicine Codes 97140 with CMT
According to the National Council on Compensation Insurance (NCCI), Medicare covers CMT of the five spinal regions. Physical medicine and rehabilitation services described by CPT codes 97112, 97124, and 97140 are not separately reportable when performed in the same spinal region that received CMT.
However, if these services are performed in a different region than the CMT, and the provider is eligible to report physical medicine services under Medicare, then the chiropractor may bill both the CMT code and the physical medicine code using modifier 59 or modifier XS (separate anatomical structure).
The Five Spinal Regions Defined by CPT
Per CPT definitions, the recognized spinal regions are:
- Cervical region (includes atlanto-occipital joint)
- Thoracic region (includes costovertebral and costotransverse joints)
- Lumbar region
- Sacral region
- Pelvic region (sacro-iliac joint)
These regions matter because payors will deny physical medicine services if they overlap with the region where the spinal manipulation occurred.
CPT Code Descriptions
97112 – Neuromuscular Reeducation
Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, coordination, balance, posture, kinesthetic sense, or proprioception for sitting or standing activities.
97124 – Massage Therapy
Therapeutic procedure, 1 or more areas, each 15 minutes; massage including effleurage, petrissage, and tapotement.
97140 – Manual Therapy
Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes.
98940-98942 – Chiropractic Spinal Manipulation
Clinical Examples for Clarity
Pay Example (Separate Regions – Billable)
A patient presents with thoracic pain and shoulder pain.
- Spinal manipulation is performed on the thoracic region.
- Massage therapy (97124) is performed on the shoulder region.
Because the shoulder is not a spinal region and is separate from the CMT area, both 97124 and 98940 may be billed. Modifier 59/XS should be applied to 97124.
Why it gets paid:
Physical medicine was performed in a different anatomical area than the spinal manipulation.
Deny Example (Same Region – Not Separately Billable)
A patient presents with cervical and thoracic pain.
- Spinal manipulation is performed in all affected spinal regions.
- 97140 manual therapy code is performed on the cervical region to loosen muscles.
In this case, only the appropriate CMT code (98940-98942) should be billed.
Why it is denied:
Manual therapy was performed in the same spinal region that underwent CMT, so procedure code 97140 is considered part of the adjustment and not separately billable.
Modifiers That Matter
Correct modifier usage is one of the most important factors in determining whether your 97140 claim gets paid or denied. When manual therapy is performed in a different, non-contiguous region from where you performed the chiropractic adjustment, you must use modifier 59 to show that the services are distinct and separate.
For example, if you adjust the lumbar spine (L3-L4) but perform manual therapy on the right shoulder, 97140 chiropractic CPT code should be billed with modifier 59 because the shoulder is not part of the spinal region treated with the adjustment. Without this modifier, most payors will automatically bundle 97140 into the CMT code and deny it as inclusive.
Some insurance companies prefer the XS modifier, which specifically identifies a “separate anatomical structure.” While it serves the same function as 97140 modifier 59, XS provides clearer region-based differentiation and is often favored in plans that follow more granular coding guidelines.
For Medicare specifically, the GP modifier is mandatory on all physical therapy-related services, including 97140. Medicare also applies strict time-based and documentation requirements, so failing to include GP will almost always result in a denial.
How Top Insurance Payors Handle 97140
Below is a consolidated table showing how major insurers view procedure code 97140, what modifiers they require, and what documentation standards they typically enforce.
Insurance Requirements for CPT 97140
| Payor | Modifier Requirements | Documentation Expectations | Notes / Common Denials |
| Medicare | GP required; 59/XS when separate region | Must follow 8-minute rule; time must be clearly documented | Frequently denies without clear time; audits same-region manual therapy + adjustment |
| Aetna | 59 or XS required for separate region | Must document distinct anatomical site | Bundles 97140 with CMT unless separate region is clearly documented |
| UnitedHealthcare (UHC) | Strongly prefers 59/XS | Therapy goals and functional deficits required | Denies if manual therapy appears routine or non-skilled |
| Blue Cross Blue Shield (varies by state) | Most require modifier 59 for separate region | Must show different techniques/regions | Some plans allow 97140 + 9894X if treatment areas differ |
| Cigna | 59/XS often required | Progress notes and functional improvement required | May require pre-authorization for repeated manual therapy |
What Your Claim Should Show
For a compliant and properly supported visit involving an adjustment plus manual therapy in a separate anatomical region, your claim should appear as:
- 98940
- 97140-59 (1 unit)
(or modifier XS if preferred by the payor; GP for Medicare)
The key is to justify exactly why each service was necessary and how you delivered it.
Documentation Must Support Your Coding
Your chiropractic SOAP notes are the primary source of proof that your billing decisions were correct. They must clearly demonstrate the necessity, intent, and effectiveness of manual therapy. Strong documentation should always include:
- A clinical rationale explaining why manual therapy was required
- Specific treatment goals related to manual therapy (pain reduction, ROM improvement, functional change)
- Objective measures used to track progress (pain scale, ROM findings, strength, tissue tone, mobility)
- Documented progression toward those goals from visit to visit
- Exact regions treated with manual therapy and with the adjustment, to demonstrate the “separate region” requirement
- A treatment plan outlining expected frequency, duration, and purpose of ongoing manual therapy
Understanding these elements, plus the importance of accurate 97140 modifier usage, ensures correct billing, reduces denials, and helps maximize reimbursement for the chiropractic services you provide.
Compliance Checklist for 97140
Before submitting a claim that includes 97140 chiropractic CPT code, it’s important to confirm that all compliance and documentation requirements have been met. This code is heavily audited, and payors expect clarity, precision, and medical necessity. You should be able to confidently answer YES to each of the following:
- Have you documented at least 8 minutes of manual therapy time?
- Was the service skilled, medically necessary, and tied to a functional deficit or diagnosis?
- Was the manual therapy performed in a different region from the spinal manipulation?
- Did you apply the correct modifier (59, XS, or GP) according to payor rules?
- Did your note include the technique used, specific anatomical site, and the functional goal of treatment?
- Would an auditor clearly understand why the patient required manual therapy?
If any answer is no, you should not bill 97140 procedure code. Payors are increasingly denying or bundling this code when documentation is vague or when anatomical regions overlap.
Final Takeaway
CPT 97140 is one of the most valuable tools in chiropractic care, when used appropriately. It can improve patient outcomes, support functional goals, and enhance overall treatment effectiveness. But because it is commonly misused, insurers closely scrutinize claims that include it. The difference between payment and denial often comes down to documentation quality, modifier accuracy, and region-specific clarity.
When billed correctly, 97140 manual therapy code can absolutely be reimbursed at its full allowable rate. When billed incorrectly, it is one of the quickest codes to be denied.
Chiropractic practices could lose revenue because of billing and coding issues. That’s why knowing what to code and when can help you get paid every time. If you want to increase the profitability of your chiropractic practice, a reliable and effective automated insurance billing system must be in place.
With zHealth chiropractic software integrated with an automated insurance billing system, it is easy to maintain code accuracy, send clean claims, and create comprehensive documents. Want to know more about when to use specific chiropractic CPT codes and how zHealth chiropractic billing software can end your coding challenges? Speak to a billing expert now!
Related Articles:
Know the Top Chiropractic CPT Codes That Can Save Your Billing Time
Chiropractic Billing Codes: Don’t Make These Mistakes
A Comprehensive Guide to CPT Code 98941 for Chiropractors
A Complete Guide to Chiropractic Billing and Coding
