What does insurance pay for CPT 98940 in California?
Anonymized historical claim benchmarks for chiropractic adjustment (1–2 regions) in California. Actual payment varies by payer, contract terms, modifiers, and documentation.
Updated April 1, 2026
How these numbers are calculated
Based on anonymized claims from practices over Jan 2024 – Dec 2025. Sample density is currently strong sample.
Figures reflect anonymized historical claim aggregates and are intended as directional benchmarks. Actual reimbursement varies by payer, contract terms, modifiers, place of service, and documentation.
Historical payment range
How billed, allowed, and paid amounts distribute across the sample.
| Metric | Average | Median |
|---|---|---|
| Billed amount | $72 | $70 |
| Allowed amount | $41 | $41 |
| Paid amount | $35 | $35 |
Claim performance
Anonymized historical signals on how cleanly these claims tend to get paid.
Common payers in the sample
Payers most often associated with this code in the historical data. Specific contracted rates with each payer remain the source of truth.
| Payer | Claims | Avg paid |
|---|---|---|
| Anthem BlueCross of California | 121 | $36 |
| Blue Shield of California | 83 | $34 |
| Aetna | 54 | $33 |
| UnitedHealthcare | 40 | $31 |
| Cigna | 26 | $31 |
Common reasons claims get denied
The denial reasons that most often appear in the historical sample for this code and state.
- Service not deemed medically necessary(CO-50)22 claims7% of sample
- Frequency of service exceeds plan limits(CO-151)19 claims6% of sample
- Pre-authorization absent or invalid(CO-197)11 claims3.5% of sample
- Diagnosis inconsistent with procedure(CO-11)8 claims2.5% of sample
Frequently asked questions
Does insurance pay for CPT 98940 in California?+
Most major commercial plans in California reimburse CPT 98940 when documentation supports medical necessity. Some plans require an active treatment plan, periodic re-exam notes, or prior authorization after a set number of visits.
What's the typical reimbursement for CPT 98940 in California?+
Anonymized historical claims show paid amounts typically fall in the range shown above. Actual payment is driven by the payer's contracted allowed amount and the patient's plan design.
How do modifiers like 25 or 59 affect payment?+
Adding modifier 25 to an E/M service on the same day as a chiropractic adjustment can change adjudication. Modifier 59 may be required when distinct services are billed together. Used incorrectly, both modifiers can trigger denials.
Why is the patient responsibility sometimes large?+
Many chiropractic benefits sit under a separate visit cap or have a higher coinsurance than primary care. High-deductible plans also push more cost to the patient until the deductible is met.
Related reimbursement pages
Explore other CPT codes and states with anonymized historical benchmarks.
- 98941 · Chiropractic adjustment (3–4 regions)CPT 98941 reimbursement in California
Chiropractic benchmarks for Chiropractic adjustment (3–4 regions) in California.
- 97810 · Acupuncture (initial 15 min)CPT 97810 reimbursement in Oregon
Acupuncture benchmarks for Acupuncture (initial 15 min) in Oregon.
- 98942 · Chiropractic adjustment (5 regions)CPT 98942 reimbursement in Texas
Chiropractic benchmarks for Chiropractic adjustment (5 regions) in Texas.
- 97811 · Acupuncture (additional 15 min)CPT 97811 reimbursement in Oregon
Acupuncture benchmarks for Acupuncture (additional 15 min) in Oregon.
- 97140 · Manual therapyCPT 97140 reimbursement in Washington
Physical Therapy benchmarks for Manual therapy in Washington.
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