Billing & Coding for Osteopathic Manipulative Treatment (OMT)

This section provides essential guidance for accurately reporting and billing for Osteopathic Manipulative Treatment (OMT). Correct coding is critical for ensuring appropriate payment.

CPT Codes for OMT

OMT is reported using CPT codes 98925-98929. These codes are defined by the number of body regions treated. The codes are cumulative, meaning you report a single code that represents the total number of regions treated.

Note: OMT is not a time based code

Key Concepts for OMT Billing

OMT and E/M Services on the Same Day:

Report the appropriate Evaluation and Management (E/M) code (e.g., 99202-99215), OMT procedure code (98925-98929), and append Modifier-25 provided both services are medically necessary and sufficiently documented.

Modifier-25

When you perform a significant, separately identifiable E/M service on the same day as OMT, you must append Modifier-25 to the E/M code.

• Example: A patient presents with acute low back pain (new problem). You perform a detailed history and exam (moderate-level MDM) and decide to treat 3 body regions with OMT.
• Bill: 99214-25 (Established patient E/M visit) + 98926 (OMT, 3-4 body regions).

Defining Body Regions

The ten body regions recognized for OMT coding are:

• Head
• Cervical
• Thoracic
• Lumbar
• Sacrum
• Pelvis
• Lower Extremities
• Upper Extremities
• Ribs
• Abdomen & Viscera

Document the specific regions treated in your SOAP note.

Documentation Requirements

Clear documentation in your SOAP note is essential for supporting OMT billing and responding to audits. Your note should include:

• Findings: The somatic dysfunction(s) diagnosed, including location (body region) and characteristics (e.g., TART criteria: Tissue texture abnormality, Asymmetry, Restriction of motion, Tenderness).
• Link to Diagnosis: A clear connection between the somatic dysfunction and the patient's chief complaint or diagnosis.
• Treatment: A record of the specific OMT techniques applied to each body region.
• Response: The patient's response to treatment.

Need More Help?

• SOAP Notes: Review our guidance on effective documentation.
• Modifier 25: Get more details on the appropriate use of this critical modifier.
• AAO Practice Management Support: The AAO has partnered with Sunrise2Sunrise (SR2), experts with over 20 years of experience, including specific expertise in OMT reporting. They can assist with complex coding questions, claims denial, and appeals. Contact the AAO for more information (fees may apply).