98926

Osteopathic Manipulative Treatment (OMT); 3 to 4 Body Regions

CPT code 98926 represents osteopathic manipulative treatment (OMT) performed on three to four distinct body regions. OMT is a specialized set of manual techniques utilized by osteopathic physicians (DOs) or qualified medical doctors to treat somatic dysfunction. Somatic dysfunction is defined as the impaired or altered function of the skeletal, arthrodial, and myofascial structures, along with their related vascular, lymphatic, and neural elements. The procedure is inherently diagnostic and therapeutic, requiring the physician to use their hands to palpate and identify specific areas of restriction, asymmetry, or tissue texture changes. For 98926, the physician must identify and treat dysfunction in three or four of the ten recognized body regions: head, cervical, thoracic, lumbar, sacral, pelvic, lower extremities, upper extremities, rib cage, and abdomen/viscera. The physician applies specific manual forces to the affected regions to improve physiological function and support homeostasis. These techniques may include high-velocity low-amplitude (HVLA) thrusts, muscle energy techniques, myofascial release, strain-counterstrain, or cranial-sacral therapy. Each treatment plan is individualized based on the patient's structural findings and clinical history. The goal of 98926 is to alleviate pain, restore normal range of motion, and improve the patient's overall structural integrity. Documentation must clearly support the presence of somatic dysfunction in every region treated and the specific manipulative techniques employed. Because OMT involves active hands-on time, the physician must reassess the patient’s structural status after the application of force to ensure a therapeutic response was achieved.

Clinical Indications

  • Somatic dysfunction of multiple body regions (3-4 regions)
  • Acute or chronic back and neck pain
  • Tension-type headaches or cervicogenic headaches
  • Rib cage restriction or pain associated with breathing
  • Sciatica or pelvic girdle pain
  • Restricted range of motion in the upper or lower extremities
  • Post-surgical musculoskeletal stiffness
  • Myofascial pain syndrome
  • Gait abnormalities related to pelvic or sacral dysfunction
  • Visceral dysfunction where manual therapy may improve lymphatic or autonomic flow

Procedure Steps

  1. Perform a structural evaluation including palpation, range of motion testing, and static/dynamic assessment of at least three to four body regions.
  2. Identify specific segments or areas exhibiting somatic dysfunction (TART: Tissue texture changes, Asymmetry, Restriction of motion, Tenderness).
  3. Explain the procedure to the patient and obtain informed consent for the specific regions to be treated.
  4. Position the patient optimally (supine, prone, or seated) for the selected manipulative technique.
  5. Apply manual forces to the first involved region using techniques such as muscle energy, myofascial release, or HVLA.
  6. Repeat the application of manual forces to the second, third, and (if applicable) fourth involved regions.
  7. Re-evaluate the treated regions via palpation and motion testing to confirm reduction in somatic dysfunction.
  8. Provide post-treatment instructions to the patient regarding hydration and activity modification.

Coding Guidelines

  • OMT codes are categorized by the number of body regions treated, not the number of techniques used.
  • The 10 body regions defined for OMT are: head, cervical, thoracic, lumbar, sacral, pelvic, lower extremities, upper extremities, rib cage, and abdomen/viscera.
  • Report 98926 only when 3 to 4 of these specific regions are treated; do not report multiple OMT codes for a single encounter.
  • A separate Evaluation and Management (E/M) service may be reported on the same day as OMT if the E/M service is significant and separately identifiable, indicated by appending modifier 25.
  • The diagnosis for OMT should typically be from the M99.0- series (Somatic dysfunction) for each specific region addressed.
  • Documentation must include the diagnosis of somatic dysfunction for every region billed.
  • OMT is a procedure and should not be billed based on time, but rather the number of regions treated.

Associated ICD-10 Codes