LCD Reference Article Billing and Coding Article

Billing and Coding: Osteopathic Manipulative Treatment

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.

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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
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

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 not recommending 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.

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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 only authorized 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 or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

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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:

  • 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.


Response To Comments

Number Comment Response
1
N/A

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
N/A

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

CPT/HCPCS Codes

Group 1

(5 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
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
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(10 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
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
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

Any diagnosis not listed in the "ICD-10 Codes That Support Medical Necessity" section.

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply 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
N/A

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 other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that 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

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

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
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
11/22/2023 R11

Revision Effective: 11/22/2023
Revision Explanation: Updated LCD Reference Article section.

11/02/2023 R10

Revision effective: 11/02/2023
Revision Explanation: Annual review, no changes 

10/27/2022 R9

Revision effective: 10/27/2022
Revision Explanation: Annual review, no changes 

10/21/2021 R8

Revision effective: 10/21/2021
Revision Explanation: Annual review

01/01/2020 R7

Revision effective: N/A
Revision Explanation: Annual review

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
Revision Explanation: Annual review conducted and corrected formatting.

10/01/2015 R4

Revision Effective date: N/A
Revision Explanation: Annual review no changes made.

10/01/2015 R3

Revision Effective date: N/A
Revision Explanation: Annual review no changes made.

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
N/A

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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SAD Process URL 1
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SAD Process URL 2
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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
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Keywords

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