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24.3.23 Osteopathic Manipulative Treatment (OMT)
OMT, performed by a provider licensed to perform OMT, is a benefit for acute situations, including acute musculoskeletal injury, acute musculoskeletal injury with a neurological component, and acute exacerbation of a chronic musculoskeletal injury. The acute modifier AT must be submitted with the claim for payment to be made.The acute phase is considered the period of time up to 180 days from the start date of therapy.
Procedure codes 1-98925, 1-98926, 1-98927, 1-98928, and 1-98929 are payable for OMTs to the head, cervical, thoracic, lumbar, sacral, pelvic, lower extremities, upper extremities, rib cage, abdominal, and viscera regions.
If procedure codes 1-98925, 1-98926, 1-98927, 1-98928, and/or 1-98929 are submitted for reimbursement with the same date of service, the most inclusive procedure code is considered for reimbursement, and the others are denied.
An E/M visit (procedure codes 1-99201, 1-99202, 1-99203, 1-99204, 1-99211, 1-99212, 1-99213, 1-99214, and 1-99215), initial subsequent care visit (procedure codes 1-99221, 1-99222, 1-99223, 1-99231, 1-99232, and 1-99233), or consultation (procedure codes 3-99251, 3-99252, 3-99253, 3-99254, and 3-99255) may be considered for reimbursement in addition to OMT, if the client's condition requires a visit for a significant and separate identifiable issue that is above and beyond the usual pre- and post-visit work associated with the OMT procedure, even if the visit and OMT are related to the same symptoms or conditions.
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