Medicare reimburses chiropractic services primarily under the PFS for manual manipulation of the spine (e.g., CPT code 98940, 98941, 98942), but specific locality-based payment amounts must be obtained from the Medicare PFS file.
Steps to get your exact 2026 chiropractic fees:
1. Go to the CMS PFS Look-Up Tool
- Use the Tool Here
- Select Calendar Year 2026.
- Enter chiropractic CPT codes (e.g., 98940–98942).
- Select California locality (Locality name/number like Northern California, Southern California, etc.).
2. Download the CMS MPFS Database
- Download the full Physician Fee Schedule files (Excel/TXT) for CY 2026 from CMS.
- Filter the data by:
HCPCS/CPT code: 98940–98942 (or other chiropractic services you bill)
Locality: specific California geographic area - Multiply the total RVUs × 2026 Conversion Factor × GPCI adjustment for the California locality to compute the allowed fee if needed.
Conversion Factor for 2026 (used to compute payment rates): - Two conversion factors exist:
Qualifying APM Participant CF ~ $33.57
Non-APM Participant CF ~ $33.40
(These are national base multipliers used with RVUs to calculate payment.) nhmh.org
3. Example Chiropractic Codes (You Will Look Up)
CPT/HCPCS CodeDescription (Common Chiropractic)
*98940* Chiropractic manipulation, 1–2 regions
*98941* Chiropractic manipulation, 3–4 regions
*98942* Chiropractic manipulation, 5 regions
(Note: Medicare typically only pays manual manipulation of the spine — ensure you verify coverage policy with CMS PFS.)
4. Quick Links to Tools and Data
Here are the official tools you’ll use to find the fee schedule data:
- CMS PFS Lookup Tool (to search 2026 fees)
Centers for Medicare & Medicaid Services - CMS Physician Fee Schedule Overview and Downloads
Centers for Medicare & Medicaid Services - Medicare PFS Data Portal (bulk data, by code)
pfs.data.cms.gov - Noridian MPFS Fees List (can be filtered for chiropractic codes)
Noridian Medicare Physician Fee Schedules
5. Locality Considerations (California)
Medicare payment rates depend on your Medicare locality within California (e.g., Northern vs. Southern California). Each locality has specific GPCI adjustments that influence the total allowed payment for a service. FCSO Medicare
- When using the look-up tool or database: Select the correct California region/locality
- Then search for the CPT code(s) you need