About this policy
Osteopathic manipulative treatment (OMT) is a treatment employed, primarily by osteopathic physicians, to facilitate a patient’s recovery from somatic dysfunction, defined under the American Osteopathic Association’s Glossary of Terminology as: impaired or altered function of related components of the somatic (body framework) system: skeletal, arthroidal and myofascial structures and related vascular, lymphatic and neuroelements. The positional and motion aspects of somatic dysfunction are best described using at least one of three parameters: 1. The position of a body part as determined by palpation and reference to its adjacent defined structure, 2. The direction in which motion is freer, and 3. The direction in which motion is restricted. Osteopathic manipulative treatment includes muscle energy, high velocity-low amplitude, counterstrain, myofascial release, visceral, and craniosacral. The chosen treatment will vary depending on patient’s age and clinical condition. Indications of Coverage Osteopathic Manipulative Treatment is covered when medically necessary and performed by a qualified physician, in patients whose history and physical examination indicate the presence of somatic dysfunction of one or more regions. Note: Osteopathic Manipulative Treatment(OMT) specifically encompasses only the procedure itself. Evaluation and management(E&M)services may be reported seperately using modifier -25 if the patient's condition requires a significant and identifiable E&M service which is above and beyond the usual pre and post service work associated with the OMT procedure; and it is appropriately documented. While the E&M service may be caused or prompted by the same symptoms or condition for which the OMT service was provided; documentation for the E&M must support this was a distinct and seperate purpose from the OMT evaluation and treatment. Different diagnoses are not required for the reporting of the OMT and E&M on the same date. Limitations of Coverage Osteopathic Manipulative Treatment is not covered when the indication of Coverage is not met, and conventional documentation of somatic dysfunction is not present in the patient's medical record Note: No E&M service is warranted for planned follow-up OMT treatments unless a new condition occurs or the patient’s condition has changed substantially, necessitating an overall reassessment.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 98925 | HCPCS | Covered |
| 98926 | HCPCS | Covered |
| 98927 | HCPCS | Covered |
| 98928 | HCPCS | Covered |
| 98929 | HCPCS | Covered |
| M99.00 | ICD10CM | Covered |
| M99.01 | ICD10CM | Covered |
| M99.02 | ICD10CM | Covered |
| M99.03 | ICD10CM | Covered |
| M99.04 | ICD10CM | Covered |
| M99.05 | ICD10CM | Covered |
| M99.06 | ICD10CM | Covered |