Billing 97140 With CMT Same Day: Modifier 59 and Regions

Yes, you can bill 97140 (manual therapy) and a spinal CMT code (98940, 98941, 98942) on the same date, but only under narrow conditions. The NCCI edit pairs each of those CMT codes with 97140 and carries modifier indicator 1, so a modifier can bypass it. The bypass is a different anatomic region, not different minutes, and CMS says to use XS when it fits and 59 only when no more specific modifier applies.

Three separate layers decide whether the line gets paid, and most explanations blur them: the NCCI edit (a coding rule), Medicare’s statutory exclusion (97140 is never covered when a chiropractor furnishes it, with or without a modifier), and each commercial or workers’ compensation payer’s own policy. At least one payer (Premera) also requires the diagnosis code on the 97140 line to name the different region. Current as of November 2026.

Can you bill 97140 and 98940 together?

You can when the manual therapy is performed in a different region than the one adjusted. The NCCI Policy Manual for Medicare Services, Chapter XI, Section S (revision date 1/1/2026), is short enough to quote in full:

“Medicare covers chiropractic manipulative treatment (CMT) of 5 spinal regions. Physical medicine and rehabilitation services described by CPT codes 97112, 97124 and 97140 are not separately reportable when performed in a spinal region undergoing CMT. If these physical medicine and rehabilitation services are performed in a different region than CMT and the provider/supplier is eligible to report physical medicine and rehabilitation codes under the Medicare program, the provider/supplier may report CMT and the above codes using modifier 59 or XS.”

Two things to take from it. First, the test is anatomic region, not time. Twelve minutes of mobilization to the lumbar spine after a lumbar adjustment is not separately reportable, however long it took. Second, the clause “eligible to report physical medicine and rehabilitation codes under the Medicare program” matters for Medicare claims, covered below.

The code descriptors frame the region question. Per the Cigna code table, 97140 is “Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes”; the AMA’s CPT page for 97140 carries the same elements: one or more regions, each 15 minutes. The CMT codes are 98940 “spinal, 1-2 regions,” 98941 “spinal, 3-4 regions,” 98942 “spinal, 5 regions,” and 98943 “extraspinal, 1 or more regions.”

The five spinal regions, per Premera’s Manipulation Services policy (CP.PP.390.v2.1, last approval 02/06/26), are cervical (including the atlanto-occipital joint), thoracic (including costovertebral and costotransverse joints), lumbar, sacral, and pelvic (sacroiliac joint). The five extraspinal regions are head (including the temporomandibular joint), lower extremities, upper extremities, rib cage, and abdomen.

What the NCCI edit rows say

In the Q4 2026 practitioner PTP file (v323r0, version 32.3, effective October 1, 2026, posted September 2, 2026), checked October 29, 2026, the relevant rows are:

The rationale on each row is “Standards of medical/surgical practice.” A star in the deletion column means the edit is active. CMT is the Column One code and 97140 is the Column Two code that denies unless a bypass modifier is appended and the circumstances justify it. Indicator 1 means a modifier is allowed to bypass the edit.

Four details that other explanations skip:

• The same three CMT codes also pair with 97124 and 97112, both with indicator 1. This post covers 97140 only.
• There is no row pairing 98943 (extraspinal CMT) with 97140, 97124, or 97112 in either direction. The edit applies to the spinal codes.
• The reverse rows are not edits. Rows listing 97140 as Column One against 98940 to 98942 carry indicator 9 with identical effective and deletion dates, the “not specified” indicator the NCCI Policy Manual, Chapter I, assigns to pairs whose deletion date equals the effective date. They were never in force.
• The October 1, 2026 update changed nothing for this pair. The Q4 2026 additions, deletions, and modifier-indicator-change files contain no rows for 98940 to 98943 or 97140, per a search of the quarterly files.

Which modifier goes on 97140 with CMT: 59 or XS?

For different anatomic regions, XS is the modifier that describes the situation. MLN1783722 says: “Use these modifiers instead of modifier 59 whenever possible. Only use modifier 59 if no other more specific modifier is appropriate.” It defines XS as “Separate structure, a service that is distinct because it was performed on a separate organ/structure,” and allows the modifiers “on Column 1 or Column 2 codes.” NCCI Policy Manual Chapter I says the same: “Modifier 59 shall only be used if no other modifier more appropriately describes the relationships of the 2 or more procedure codes.”

Use 59 when the payer’s policy names it. Minnesota workers’ compensation does (see the payer table). Use XS when the payer accepts the X modifiers. Chapter XI itself lists “modifier 59 or XS” for this pair. The general rules for choosing among 59 and the X modifiers are in NCCI edits and modifier 59 for therapy.

The modifier is a claim to be verified, not a bypass you are owed. Chapter I warns: “Modifier 59 and other NCCI PTP-associated modifiers should not be used to bypass a PTP edit unless the proper criteria for use of the modifier are met. Documentation in the medical record must satisfy the criteria required by any NCCI PTP-associated modifier used.” MLN1783722 repeats it: “Medical documentation must support the use of the modifier.”

Does Medicare pay a chiropractor for 97140?

No. The bypass above is for practitioners who can bill 97140 to Medicare, and a chiropractor cannot. The Medicare Benefit Policy Manual, Chapter 15 (Rev. 13889, issued 07-30-26), §30.5, says: “Coverage extends only to treatment by means of manual manipulation of the spine to correct a subluxation provided such treatment is legal in the State where performed. All other services furnished or ordered by chiropractors are not covered.” Section 240.1.1 adds: “No other diagnostic or therapeutic service furnished by a chiropractor or under the chiropractor’s order is covered.” The statute behind this, 42 U.S.C. 1395x(r)(5), treats a chiropractor as a physician only “with respect to treatment by means of manual manipulation of the spine (to correct a subluxation).”

So on a Medicare claim from a DC, 97140 with 59 or XS still denies. The denial is statutory, not an NCCI edit, and that is what the “eligible to report physical medicine and rehabilitation codes” clause in Chapter XI acknowledges.

What to submit instead, per Noridian’s chiropractic claim page (last updated November 18, 2024):

• Services like physical therapy rendered by a chiropractor “are not required to be submitted for coverage consideration by the Medicare program.”
• To submit a non-covered service anyway, append GY “to indicate that the service is statutorily excluded from coverage,” and “Covered and non-covered services may be billed on the same claim.”
• “Therapy services provided by a chiropractor, although non-covered, must be submitted according to therapy guidelines. Therefore, be sure to include one of the therapy modifiers on a claim.” Without it, the claim is rejected as unprocessable.

No ABN is required for a statutorily excluded service. Per MLN006266: “You don’t need to notify the patient before you provide an item or service we never cover or that isn’t a Medicare benefit.” A voluntary notice (modifier GX) is a courtesy that “doesn’t affect financial liability.” The GA, GX, GY, and GZ decision table is in ABN modifiers for therapy, and the chiropractic side is in Medicare chiropractic billing.

Who can use the bypass on a Medicare claim: the manual’s clause points to practitioners who are eligible to report physical medicine codes to Medicare, such as an MD, DO, or PT billing under that practitioner’s own enrollment and subject to the therapy billing rules that apply to them. The practical case is a multidisciplinary clinic where a PT performs 97140 on the shoulder on the same day the DC adjusts the lumbar spine.

What the note has to show for a separate region

Documentation is what makes the modifier true. A note that supports 97140 with CMT contains:

1. The spinal region(s) adjusted, by name, with the diagnosis at that level.
2. The region where manual therapy was performed, by name, stated as a different region. Minnesota’s rule says “different region(s)/body part”; Premera says “different anatomic spinal or extraspinal regions (ex. lumbar/thoracic).”
3. The technique. The 97140 descriptor lists mobilization/manipulation, manual lymphatic drainage, and manual traction. Cigna’s policy lists “soft tissue mobilization, joint mobilization, and manual lymphatic drainage.”
4. The minutes of direct one-on-one time.
5. A diagnosis pointer on the 97140 line that names the manual therapy region, distinct from the CMT diagnosis. Premera requires it, and Kaiser Permanente Washington denies the service when the diagnosis code is the same.
6. Why both were needed, tied to a treatment plan. Cigna says “all services must be supported in the treatment plan”; the Louisiana Medicaid policy below requires treatments to be “identified in the documented treatment plan”; Aetna says adjunctive modalities “must augment or enhance the manipulative treatment.”
7. The modifier: XS where accepted, 59 where required or where the payer has not adopted X modifiers.

A worked example

This is a hypothetical, with no patient details. A DC adjusts the cervical and thoracic spine (98940, two regions, diagnoses for segmental dysfunction at both), then spends 12 minutes on joint mobilization to the right shoulder (upper extremity region, with a shoulder diagnosis).

Now change the example: the 12 minutes of mobilization go to the lumbar spine after a lumbar adjustment. Under Chapter XI, Section S, that service is not separately reportable. On Premera it denies “as included in the CMT service.”

One caution on contiguous regions. The NCCI language is “a different region.” CMS does not define contiguity for this code pair, and the claim that adjacent regions such as cervical and thoracic are “contiguous and therefore bundled” is not in the manual. The manual’s test is region. The safest different region is an extraspinal one, or a spinal region not among those adjusted.

How many minutes does 97140 need, and can you use modifier 52?

97140 is a timed code, and CMT is untimed (one unit per session). The Medicare Claims Processing Manual, Chapter 5, §20.2 says these codes specify “that the direct (one on one) time spent in patient contact is 15 minutes.” For a single timed code in a day, “providers bill a single 15-minute unit for treatment greater than or equal to 8 minutes through and including 22 minutes.”

First Coast Service Options, in its counting units page (February 18, 2026), says: “Services provided for a single timed CPT code that is less than eight minutes should not be billed.” The CMS manuals and MAC pages reviewed do not authorize modifier 52 for a timed therapy code under 8 minutes, and that page does not mention it. At least one commercial payer prohibits it: Premera’s Modifier 52 policy (CP.PP.224.v3.3, last approval 02/06/26) says it “is not valid when submitted with any time-based codes, including but not limited to anesthesia, psychotherapy, critical care, or physical medicine time-based codes.” Other payers may differ, so check each one. Full counting rules are in the 8-minute rule guide, and the timed/untimed distinction is in timed vs untimed CPT codes.

Minutes do not rescue a same-region service. The manual’s general language about bypassing edits when two timed codes occur in different timed intervals concerns timed-with-timed pairs. For CMT and 97140, Section S’s region test is the specific rule.

How commercial payers and workers’ comp treat 97140 with CMT

Each payer writes its own rule. These are the rows verified from primary documents as of October 29, 2026.

Patterns worth noticing: the strictest verified rule (Premera) checks region through the ICD-10 code on the line, not just the modifier. Minnesota requires 59 specifically. Cigna’s cap counts timed codes per visit. Kaiser’s policy restricts the supportive services reimbursed with manipulation. American Specialty Health’s own CPG 278 sits behind a provider login and was not reviewed. Payer policies change, so confirm the current version before you build a billing rule on one.

What changes on January 1, 2027

CMS Transmittal 13946 (Pub. 100-04, Change Request 14611, dated September 17, 2026) announces NCCI PTP edits version 33.0, effective January 1, 2027, with an implementation date of January 4, 2027. Test files are expected “on or about November 2, 2026” and final files “on or about November 17, 2026.” The transmittal does not list code pairs, so whether the 98940 to 98942 and 97140 rows change in v33.0 is not known until the files post. Until then, v323r0 is the file in force, and the Chapter XI language quoted above is from the manual’s 1/1/2026 revision.

Separately, Cigna’s CPG 278 has a next review date of 12/15/2026, and Aetna’s CPB 0107 is next due 01/28/2027.

Checklist before you send 97140 with CMT

• Is this a Medicare claim billed by a DC? If so, 97140 is excluded. Noridian directs GY plus a therapy modifier; there is no edit to bypass, so 59 or XS does nothing.
• Is the manual therapy in a region you did not adjust? If not, do not bill it separately.
• Is the CMT code spinal (98940 to 98942)? There is no NCCI row against 98943, though Minnesota workers’ comp restricts it.
• Does the note name both regions, the technique, the minutes, and why both services were needed?
• Do the diagnosis pointers differ between the CMT line and the 97140 line?
• Are there at least 8 direct minutes for one unit, and no modifier 52 unless the payer allows it?
• XS or 59? Check the payer’s own policy.
• Does the visit stay within the payer’s timed-code cap (Cigna: 4 per date of service)?

Rules like these vary by payer and by claim, which makes them poor candidates for memory. PrismEHR lets organizations define their own billing rules, including restrictions by code and payer, enforced at the point of documentation and reinforced at claim creation. That can mean blocking 97140 on a Medicare CMT claim or forcing GY and the therapy modifier onto it, requiring a region and minutes on the 97140 note before XS or 59 can attach, and applying a different rule for a workers’ comp payer that wants 59. See how it fits chiropractic practices, and read about same-day E/M with CMT and modifier 25.