Osteopathic Manipulation Therapy Coding Guidelines

The following coding guidelines should be used when coding/billing Osteopathic Manipulation Therapy:

         Osteopathic manipulative treatment includes a pre and post manipulation assessment. Pre-service work includes: reviewing previously gathered clinical data, an initial or interim history, reviewing the problem list, pertinent correspondence or reports, other important findings, prior care, review of imaging and other test results, test interpretation, and care planning.

         Osteopathic manipulation to regions of the body that does not correlate with specific regions where somatic (bodily) dysfunction is documented by the physical examination will not be covered.

         OMT may be done in any appropriate setting such as hospital, office or home.

         The outcome or response to treatment must be included in the record.

         The plan for ongoing care is noted.

         In addition, treatment will not be routinely reimbursed in more than two claims. If two body regions are allowed and treated, one in each of two claims, CPT code 98925 may be billed in each claim with BWC modifier PC for the primary claim and SC for the second claim.

         If a total of three or four body regions are allowed and treated in two claims, two in one claim and one or two in a second claim, each claim may be coded with 98926. For the primary or most significant claim, modifier PC must be addedtothe code. Modifier SC must be added to the code in the second claim.

         If a total of five or six body regions are allowed and treated in two claims, each service may be coded with 98927. For the primary or most significant service, modifier PC must be addedtothe code. Modifier SC must be added to the code in the second claim.

 

The OMT procedure codes are related almost exclusively to the somatic (bodily) dysfunction codes. An E/M service may be billed on the same day as OMT if the service is significant and separately identifiable from the OMT, and CPT modifier 25 is used.

         Examples could include the first visit, at which a patient is examined, or when a significant change in the patient's condition warrants an additional evaluation.

         An E/M service should also be reported if work is done that is not included in the OMT (e.g., change of medications, review of additional or new data, or the ordering of laboratory imaging studies, x-rays, or additional studies).

 

Body regions referred to are: head region; cervical region; thoracic region; lumbar region; sacral region; pelvic region; lower extremities, upper extremities; rib cage region; abdomen and viscera region.

CPT codes

98925

Osteopathic manipulation (1-2 body regions)

98926

Osteopathic manipulation (3-4 body regions)

98927

Osteopathic manipulation (5-6 body regions)

98928

Osteopathic manipulation (7-8 body regions)

98929

Osteopathic manipulation (9-10 body regions)