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25.3.3.29 Osteopathic Manipulation Treatments (OMT)
OMT is a benefit of the Texas Medicaid Program for the acute phase of the acute musculoskeletal injury or the acute phase of an acute exacerbation of a chronic musculoskeletal injury including acute musculoskeletal injury with a neurological component. The acute modifier AT must be submitted with the claim for payment to be made.
The AT modifier is described as representing treatment provided for an acute condition, or an exacerbation of a chronic condition, which persists less than 180 days from the start date of therapy. If the condition persists for more than 180 days from the start of therapy, the condition is considered chronic, and treatment is no longer considered acute. Providers may file an appeal for claims denied as being beyond the 180 days of therapy with supporting documentation that the client's condition has not become chronic and the client has not reached the point of plateauing. Plateauing is defined as the point at which maximal improvement has been documented and further improvement ceases.
Use procedure codes 1-98925, 1-98926, 1-98927, 1-98928, and 1-98929 when billing for OMT to the head, cervical, thoracic, lumbar, sacral, pelvic, lower extremities, upper extremities, rib cage, abdominal, and visceral regions.
When multiples of procedure codes 1-98925, 1-98926, 1-98927, 1-98928, and 1-98929 are billed on the same day by the same provider, the most inclusive code is paid and the others denied.
Procedure code 1-97140 will deny as part of another service if billed on the same date of service as procedure codes 98925, 98926, 98927, 98928, or 98929.
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