LCD Reference ArticleBilling and Coding Article
A52435
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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
NOT AN LCD REFERENCE ARTICLE
This article is not in direct support of an LCD. Learn more
Document Note
Note History
Contractor Information
Article Information
General Information
Source Article ID
N/A
Article ID
A52435
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Osteopathic Manipulative Treatment
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
11/22/2023
Revision Ending Date
N/A
Retirement Date
N/A
CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is notrecommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services.The AMA assumes no liability for data contained or not contained herein. Current Dental Terminology © 2023 American Dental Association. All rights reserved. Copyright © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission.No portion of the AHA copyrighted materials contained within this publication may becopied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes anddescriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative workwithout the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes,resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions;and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is onlyauthorized with an express license from the American Hospital Association.The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness oraccuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in thepreparation of this material, or the analysis of information provided in the material. The views and/or positionspresented in the material do not necessarily represent the views of the AHA. CMS and its products and services arenot endorsed by the AHA or any of its affiliates.
CMS National Coverage Policy
N/A
Article Guidance
Article Text 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: 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.
Response To Comments
| Number | Comment | Response |
|---|---|---|
| 1 |
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Coding Information
Bill Type Codes
| Code | Description |
|---|---|
| 011x | Hospital Inpatient (Including Medicare Part A) |
| 012x | Hospital Inpatient (Medicare Part B only) |
| 013x | Hospital Outpatient |
| 021x | Skilled Nursing - Inpatient (Including Medicare Part A) |
| 022x | Skilled Nursing - Inpatient (Medicare Part B only) |
| 023x | Skilled Nursing - Outpatient |
| 071x | Clinic - Rural Health |
| 073x | Clinic - Freestanding |
| 077x | Clinic - Federally Qualified Health Center (FQHC) |
| 085x | Critical Access Hospital |
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Revenue Codes
| Code | Description |
|---|---|
| 0516 | Clinic - Urgent Care Clinic |
| 0517 | Clinic - Family Practice Clinic |
| 0531 | Osteopathic Services - Osteopathic Therapy |
| 0983 | Professional Fees - Clinic |
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CPT/HCPCS Codes
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Group 1
(5 Codes)
Group 1 Paragraph N/A
| Code | Description |
|---|---|
| 98925 | Osteopath manj 1-2 regions |
| 98926 | Osteopath manj 3-4 regions |
| 98927 | Osteopath manj 5-6 regions |
| 98928 | Osteopath manj 7-8 regions |
| 98929 | Osteopath manj 9-10 regions |
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CPT/HCPCS Modifiers
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Group 1
Group 1 Paragraph N/A
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ICD-10-CM Codes that Support Medical Necessity
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Group 1
(10 Codes)
Group 1 Paragraph N/A
| Code | Description |
|---|---|
| M99.00 | Segmental and somatic dysfunction of head region |
| M99.01 | Segmental and somatic dysfunction of cervical region |
| M99.02 | Segmental and somatic dysfunction of thoracic region |
| M99.03 | Segmental and somatic dysfunction of lumbar region |
| M99.04 | Segmental and somatic dysfunction of sacral region |
| M99.05 | Segmental and somatic dysfunction of pelvic region |
| M99.06 | Segmental and somatic dysfunction of lower extremity |
| M99.07 | Segmental and somatic dysfunction of upper extremity |
| M99.08 | Segmental and somatic dysfunction of rib cage |
| M99.09 | Segmental and somatic dysfunction of abdomen and other regions |
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ICD-10-CM Codes that DO NOT Support Medical Necessity
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Group 1
Group 1 Paragraph Any diagnosis not listed in the "ICD-10 Codes That Support Medical Necessity" section.
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ICD-10-PCS Codes
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Group 1
Group 1 Paragraph N/A
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Additional ICD-10 Information
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Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typicallyused to report this service. Absence of a Bill Type does not guarantee that thearticle does not apply to that Bill Type. Complete absence of all Bill Types indicatesthat coverage is not influenced by Bill Type and the article should be assumed toapply equally to all claims.
| Code | Description |
|---|---|
| 011x | Hospital Inpatient (Including Medicare Part A) |
| 012x | Hospital Inpatient (Medicare Part B only) |
| 013x | Hospital Outpatient |
| 021x | Skilled Nursing - Inpatient (Including Medicare Part A) |
| 022x | Skilled Nursing - Inpatient (Medicare Part B only) |
| 023x | Skilled Nursing - Outpatient |
| 071x | Clinic - Rural Health |
| 073x | Clinic - Freestanding |
| 077x | Clinic - Federally Qualified Health Center (FQHC) |
| 085x | Critical Access Hospital |
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Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service.In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under otherRevenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicatesthat coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.
| Code | Description |
|---|---|
| 0516 | Clinic - Urgent Care Clinic |
| 0517 | Clinic - Family Practice Clinic |
| 0531 | Osteopathic Services - Osteopathic Therapy |
| 0983 | Professional Fees - Clinic |
N/A
Other Coding Information
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Group 1
Group 1 Paragraph N/A
N/A
N/A
Coding Table Information
Excluded CPT/HCPCS Codes - Table Format
| Code | Descriptor Generic Name | Descriptor Brand Name | Exclusion Effective Date | Exclusion End Date | Reason for Exclusion |
|---|---|---|---|---|---|
| N/A | N/A |
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
| Code | Descriptor Generic Name | Descriptor Brand Name | Exclusion Effective Date | Exclusion End Date | Reason for Exclusion |
|---|
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Revision History Information
| Revision History Date | Revision History Number | Revision History Explanation |
|---|---|---|
| 11/22/2023 | R11 | Revision Effective: 11/22/2023 |
| 11/02/2023 | R10 | Revision effective: 11/02/2023 |
| 10/27/2022 | R9 | Revision effective: 10/27/2022 |
| 10/21/2021 | R8 | Revision effective: 10/21/2021 |
| 01/01/2020 | R7 | Revision effective: N/A |
| 01/01/2020 | R6 | Revision Effective: 01/01/2020 Revision Explanation: Converted to new billing and coding article format. |
| 11/28/2019 | R5 | Revision Effective date:11/28/2019 |
| 10/01/2015 | R4 | Revision Effective date: N/A |
| 10/01/2015 | R3 | Revision Effective date: N/A |
| 10/01/2015 | R2 | Revision Effective date: N/A Revision Explanation: Annual review no changes made. |
| 10/01/2015 | R1 | Revision effective: N/A Revision Explanation: Annual review |
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Associated Documents
Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
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Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
| Updated On | Effective Dates | Status | |
|---|---|---|---|
| 11/15/2023 | 11/22/2023 - N/A | Currently in Effect | You are here |
| 10/27/2023 | 11/02/2023 - 11/21/2023 | Superseded | View |
| 10/21/2022 | 10/27/2022 - 11/01/2023 | Superseded | View |
| Some older versions have been archived. Please visit theMCD Archive Site to retrieve them. | |||
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