2025 CPT code 98927
(Active) Effective Date: N/A Medicine Services and Procedures - Osteopathic Manipulative Treatment Procedures Feed
Osteopathic manipulative treatment (OMT) of five to six body regions.
Modifier 25 can be appended to an E/M code when a significant, separately identifiable E/M service is performed on the same day as OMT.
Medical necessity for OMT should be supported by documentation demonstrating the presence of somatic dysfunction, the impact on the patient's function and mobility, and the rationale for the chosen treatment approach. Payer-specific guidelines regarding medical necessity for OMT should always be followed.
The physician or other qualified healthcare professional providing OMT is responsible for assessing the patient's condition, determining the appropriate treatment areas and techniques, and performing the manipulative treatment. They must also document the specific body regions treated and the techniques used.
In simple words: The doctor uses their hands to apply controlled pressure and movement to five or six areas of your body. This treatment, called osteopathic manipulative treatment (OMT), helps with problems like muscle or joint pain, stiffness, and other related issues. It can also help with conditions like asthma, migraines, and sinus problems.
This code describes osteopathic manipulative treatment (OMT) applied to five to six body regions. OMT is a form of manual treatment used to address somatic dysfunction and related disorders. It involves various techniques to alleviate or eliminate these conditions.The body regions referred to in OMT coding include the head, cervical, thoracic, lumbar, sacral, pelvic regions, as well as the upper and lower extremities, rib cage, abdomen, and viscera.
Example 1: A patient presents with lower back pain radiating into the right leg, along with limited range of motion in the lumbar spine. The physician performs OMT on five regions: lumbar, sacral, pelvis, right lower extremity, and abdomen., A patient with a history of migraines experiences a new episode with associated neck stiffness. The physician performs OMT on the head, cervical, thoracic, and rib cage regions, totaling four regions. In this case, 98926 would be the more appropriate code., A patient with shoulder pain and restricted movement receives OMT on the cervical, thoracic, and upper extremity regions on one side of the body. Since only three regions are involved, CPT code 98926 is reported.
Documentation for OMT should include the specific body regions treated, the techniques employed, the patient's presenting symptoms and diagnosis, and any improvement or changes observed following treatment. It's also important to note the total number of body regions involved to ensure accurate coding.
- Revenue Code: P6C - MINOR PROCEDURES - OTHER (MEDICARE FEE SCHEDULE)
- Specialties:Osteopathic physicians, family medicine, physical medicine and rehabilitation, and other specialties that utilize OMT.
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Skilled Nursing Facility, Nursing Facility and other places of service where OMT is performed.