98925

Osteopathic Manipulative Treatment (OMT); 1-2 body regions involved

Osteopathic Manipulative Treatment (OMT) is a comprehensive set of manual clinical techniques utilized by osteopathic physicians (DOs) or other qualified healthcare professionals to diagnose, treat, and prevent illness or injury. CPT code 98925 specifically describes the application of these manual therapies to one or two distinct body regions. For coding purposes, the body is divided into ten recognized regions: the head (including the cranial bones and temporomandibular joint), cervical (neck), thoracic (upper and middle back), lumbar (lower back), sacral (base of the spine), pelvic (including the hip and iliac bones), lower extremities (legs and feet), upper extremities (shoulders, arms, and hands), rib cage (costal structures), and the abdomen/viscera. OMT is grounded in the osteopathic philosophy that the body’s structure and function are interrelated and that the body possesses self-healing mechanisms. During the procedure, the physician applies manually directed forces to address somatic dysfunction, which is defined as impaired or altered function of the skeletal, arthrodial, and myofascial structures and their related vascular, lymphatic, and neural elements. The physician selects from various modalities based on the patient’s clinical needs, such as High-Velocity Low-Amplitude (HVLA) thrusts, Muscle Energy techniques (using the patient’s own muscle contractions), Myofascial Release, or Osteopathic Cranial Manipulative Medicine. These maneuvers aim to improve joint mobility, enhance tissue perfusion, facilitate lymphatic drainage, and balance autonomic nervous system activity. The 98925 code represents the professional work involved in the physical manipulation itself, which must be supported by documented findings of somatic dysfunction in the regions treated. It is a distinct service from a diagnostic evaluation and management (E/M) encounter, though both may occur on the same day if criteria are met.

Clinical Indications

  • Somatic dysfunction of the cervical, thoracic, or lumbar spine
  • Tension-type headaches or migraines secondary to musculoskeletal restriction
  • Acute or chronic low back pain
  • Neck pain or torticollis
  • Rib dysfunction and associated respiratory restriction
  • Pelvic tilt or sacroiliac joint dysfunction
  • Myofascial pain syndromes
  • Upper or lower extremity joint restriction
  • Visceral dysfunction impacting autonomic tone
  • Post-surgical recovery to improve lymphatic drainage and mobility

Procedure Steps

  1. Perform a comprehensive structural examination to identify areas of somatic dysfunction.
  2. Document findings using the TART criteria: Tissue texture changes, Asymmetry, Restriction of motion, and Tenderness.
  3. Position the patient appropriately for the chosen manual technique (supine, prone, lateral recumbent, or seated).
  4. Apply specific osteopathic techniques such as Myofascial Release, Muscle Energy, or High-Velocity Low-Amplitude (HVLA) thrusts to the target region.
  5. Engage the restrictive barrier or move the tissue toward the position of ease depending on the technique (direct vs. indirect).
  6. Maintain force or position for the required therapeutic duration to achieve tissue release or joint mobilization.
  7. Re-evaluate the treated regions for changes in symmetry, range of motion, and tissue quality.
  8. Provide post-treatment instructions to the patient regarding hydration and activity modification.

Coding Guidelines

  • OMT is a procedure and is not included in the Evaluation and Management (E/M) service.
  • If a separate, identifiable E/M service is performed on the same day as OMT, append modifier -25 to the E/M code.
  • The 10 body regions defined for OMT are: head, cervical, thoracic, lumbar, sacral, pelvic, lower extremities, upper extremities, rib cage, and abdomen/viscera.
  • Code 98925 should only be used when 1 or 2 of these regions are treated.
  • Documentation must include the specific somatic dysfunction (ICD-10 M99 series) for each region treated.
  • Diagnosis codes for somatic dysfunction are typically required to justify the medical necessity of OMT.
  • Do not report OMT in conjunction with Physical Medicine and Rehabilitation codes (e.g., 97110, 97140) for the same body region on the same day unless they are distinct services.

Associated ICD-10 Codes