2025 CPT code 98928
(Active) Effective Date: N/A Revision Date: N/A Medicine - Osteopathic Manipulative Treatment Procedures Medicine Services and Procedures Feed
Osteopathic manipulative treatment (OMT) involving seven to eight body regions.
Modifier 25 (Significant, separately identifiable E/M service) may be appended when appropriate. Other modifiers may apply based on individual circumstances; consult payer policies.
Medical necessity for OMT is established when the patient presents with musculoskeletal complaints, somatic dysfunction, or other conditions that are amenable to this type of treatment.Documentation supporting the diagnosis, clinical findings, and the expectation of improvement through OMT must be present.
The physician is responsible for performing a thorough examination, determining the appropriate body regions requiring treatment, and executing the OMT techniques.They should also document the procedure completely, including the regions treated and patient response.
In simple words: The doctor uses their hands to gently adjust muscles and joints in seven to eight areas of your body to relieve pain and improve movement. This helps with problems like back pain, headaches, or other aches and pains.
This CPT code, 98928, represents osteopathic manipulative treatment (OMT) encompassing seven to eight body regions.OMT is a hands-on approach where a physician applies controlled manual pressure to muscles and joints to address somatic (muscle and joint-related) and nonsomatic (other) disorders. The treatment aims to improve joint mobility, alleviate pain, and restore normal musculoskeletal function.Seven to eight body regions may include the head, neck, thorax, lumbar spine, sacrum, pelvis, upper extremities, lower extremities, abdomen, and rib cage.An evaluation and management (E/M) service may be separately reported with modifier 25 if a significant, separately identifiable E/M service is performed beyond the usual pre- and post-service work.
Example 1: A patient presents with chronic low back pain radiating into the right leg.The physician performs OMT on the lumbar spine, sacrum, pelvis, right hip, and right lower extremity (5 regions), requiring a second session to address the neck, upper back and upper extremities for a total of 8 regions., A patient experiencing widespread musculoskeletal pain following a motor vehicle accident. The physician performs a comprehensive OMT session involving the neck, upper back, lower back, pelvis, hips, and both upper and lower extremities. This treatment involves at least seven to eight regions., A patient with chronic headaches and TMJ dysfunction undergoes OMT addressing the head, neck, cervical spine, jaw, and upper extremities.
Detailed documentation should include:*Patient history and presenting complaint.*Physical examination findings, including specific areas of somatic dysfunction.*Number of body regions treated.*Specific OMT techniques used.*Patient response to treatment.*Physician's plan of care.
** Always verify payer-specific coding policies and guidelines before submitting claims.The specific body regions treated should be clearly documented to ensure accurate coding.
- Revenue Code: P6C (Medicare Fee Schedule: MINOR PROCEDURES - OTHER)
- RVU: This information is not available in the provided source.RVUs vary based on geographic location and payer.
- Global Days: The provided source does not specify the global period for this procedure.This should be determined by payer policy.
- Payment Status: Active
- Modifier TC rule: No TC modifier is applicable to 98928.
- Fee Schedule: Fee schedules vary widely by location and payer.Historical fee information is not included in this source.
- Specialties:Osteopathic Medicine, Family Medicine, Sports Medicine
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital, Other