Overview
CPT® Code 98926 is used to report osteopathic manipulative treatment (OMT) delivered to 3–4 body regions during a single patient encounter. OMT involves hands-on techniques performed by a physician or qualified healthcare professional to evaluate and treat somatic dysfunction, improve joint mobility, reduce pain, and support the body’s natural function. This code covers the therapeutic service itself; evaluation, counseling, or additional procedures are documented and billed separately.
Key Facts About CPT® 98926
- Service type: Osteopathic manipulative treatment (OMT)
- Provider type: Osteopathic physicians (DOs) or other qualified professionals trained in OMT
- Medical services included: Yes—hands-on treatment for 3–4 body regions
- Body regions: Commonly cervical, thoracic, lumbar, sacral, pelvic, upper extremities, or lower extremities
- Typical clinical indications:
- Musculoskeletal pain (back, neck, joints)
- Headaches or tension-related disorders
- Postural imbalances or scoliosis
- Recovery after injury or surgery
- Chronic somatic dysfunction or limited mobility
When to Use CPT® 98926
CPT 98926 is appropriate when:
- OMT is performed on 3–4 distinct body regions during a single session
- Treatment is medically necessary to address pain, mobility limitations, or somatic dysfunction
- Documentation specifies the regions treated and techniques used
Examples:
- Treating a patient with thoracic spine, lumbar spine, and sacral dysfunction in one session.
- Combining upper and lower extremity manipulation for mobility and pain relief.
For more regions treated:
- CPT 98925 → 1–2 regions
- CPT 98927 → 5 regions
Documentation Requirements
To properly support CPT 98926 billing, include:
- Patient identifiers and date of service
- 3–4 body regions treated
- Specific manipulative techniques applied
- Clinical indication for OMT
- Response to treatment and follow-up recommendations
- Any coexisting conditions addressed
Accurate documentation ensures proper reimbursement, compliance, and continuity of care.
Reimbursement and Coding Considerations
- Covered by most commercial insurers and Medicare when medically necessary
- Report one code per session based on number of regions treated
- Documentation must justify medical necessity and region count
- Modifiers may be required if OMT is combined with other procedures or multiple sessions
- OMT must be billed separately from E/M or other therapeutic services
How OptiMantra Supports Osteopathic Manipulative Treatment
OptiMantra’s integrated EMR and practice management system streamlines OMT documentation and billing for CPT 98926.
With OptiMantra, providers can:
- Document body regions and techniques directly in the patient chart
- Use templates designed specifically for hands-on therapeutic services
- Track patient progress and response to treatment over multiple sessions
- Generate audit-ready billing codes for each OMT session
- Integrate OMT documentation with broader care plans, including E/M visits or other therapies
By centralizing OMT charting and billing workflows, OptiMantra helps osteopathic and integrative practices provide comprehensive care while maintaining accurate records and maximizing reimbursement.
Try OptiMantra for free here!
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