Introduction
Osteopathic Manipulative Treatment (OMT) is a hands-on therapy used by osteopathic physicians (DOs) to diagnose and treat musculoskeletal conditions. Proper CPT coding ensures accurate reimbursement and prevents denials due to incorrect modifier use or bundling issues. This guide covers key CPT codes for OMT, billing guidelines, modifier use, and a final reference table with CPT descriptions and RVUs.
Understanding OMT Coding
OMT involves the application of manual techniques to treat somatic dysfunctions in various body regions. The CPT coding is determined by the number of body regions treated.
CPT Codes for OMT
OMT CPT Codes by Region Count
- 98925 – OMT, 1-2 body regions.
- 98926 – OMT, 3-4 body regions.
- 98927 – OMT, 5-6 body regions.
- 98928 – OMT, 7-8 body regions.
- 98929 – OMT, 9-10 body regions.
Commonly Treated Body Regions in OMT
- Head
- Cervical spine
- Thoracic spine
- Lumbar spine
- Sacrum
- Pelvis
- Upper extremities
- Lower extremities
- Rib cage
- Abdomen & viscera
Billing Guidelines & Modifier Usage
- Common Modifiers:
- -25 – Used if an E/M service is performed on the same day as OMT.
- -59 – Used if OMT is performed separately from another procedural service.
- -GP – Indicates services provided under a therapy plan of care.
- Bundling Considerations:
- OMT codes (98925-98929) should not be reported with chiropractic manipulation codes (98940-98942).
- Use modifier -25 if an E/M visit is billed on the same day as OMT.
Common Denials & How to Avoid Them
- Medical Necessity Denials: Ensure documentation supports somatic dysfunction diagnosis and necessity for OMT.
- Modifier Use Issues: Append -25 when OMT is performed on the same day as an evaluation.
- Duplicate Claim Rejections: Avoid submitting multiple OMT claims for the same session without medical justification.
Final CPT Code Table: Descriptions & RVUs
| CPT Code | Description | RVU |
|---|---|---|
| 98925 | OMT, 1-2 body regions | 0.90 |
| 98926 | OMT, 3-4 body regions | 1.20 |
| 98927 | OMT, 5-6 body regions | 1.50 |
| 98928 | OMT, 7-8 body regions | 1.75 |
| 98929 | OMT, 9-10 body regions | 2.00 |
Conclusion
Accurate CPT coding for Osteopathic Manipulative Treatment (OMT) is essential for maximizing reimbursement and preventing denials. Understanding modifier use, bundling rules, and payer-specific guidelines will help ensure accurate claims.
If this guide was useful, check out our other manual therapy CPT coding guides on chiropractic manipulation, physical therapy, and sports medicine!