How To Use CPT Code 98926

CPT 98926 describes the procedure of osteopathic manipulative treatment (OMT) involving three to four body regions. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 98926?

CPT 98926 is used to describe a specific procedure called osteopathic manipulative treatment (OMT) that involves the application of controlled manual pressure on three to four body regions. This treatment is performed by a healthcare provider to address somatic and nonsomatic disorders. By manipulating the movement of muscles and joints, the provider helps relax the affected areas, improve mobility, and alleviate pain. OMT can be used to treat various conditions, including muscle and joint-related disorders, as well as nonsomatic disorders such as asthma, migraines, carpal tunnel syndrome, sinus disorders, and menstrual discomfort.

2. Official Description

The official description of CPT code 98926 is: ‘Osteopathic manipulative treatment (OMT); three to four body regions involved.’

3. Procedure

1. The healthcare provider performs controlled manual pressure on three to four body regions.
2. The pressure is applied in a specific manner over the affected area or the areas surrounding it.
3. The provider may apply pressure on various body regions, including the abdomen, chest, head, neck, hip, spine, and extremities.
4. The pressure helps relax muscles and joints, improving their mobility and reducing pain.
5. OMT can be used to treat both somatic and nonsomatic disorders.

4. Qualifying circumstances

CPT 98926 is appropriate for patients who require osteopathic manipulative treatment involving three to four body regions. This treatment is suitable for individuals with somatic and nonsomatic disorders, including muscle and joint-related conditions, as well as other specific ailments such as asthma, migraines, carpal tunnel syndrome, sinus disorders, and menstrual discomfort. The provider must apply controlled manual pressure in a specific manner to the affected areas or their surrounding regions.

5. When to use CPT code 98926

CPT code 98926 should be used when a healthcare provider performs osteopathic manipulative treatment involving three to four body regions. This code is appropriate for patients who require this specific treatment and should not be used for other variations of OMT involving a different number of body regions. It is important to accurately document the regions involved in the treatment to ensure proper coding and billing.

6. Documentation requirements

To support a claim for CPT 98926, the healthcare provider must document the following information:

• The specific body regions involved in the osteopathic manipulative treatment
• The date of the treatment
• The start and end time of the procedure
• Any significant findings or observations during the treatment
• Progress made by the patient
• Signature of the healthcare provider performing the treatment

7. Billing guidelines

When billing for CPT 98926, ensure that the procedure involves three to four body regions and is performed by a qualified healthcare provider. It is important to accurately document the regions involved to support the claim. Additionally, check payer policies to determine if a significant, separately identifiable evaluation and management (E/M) service can be reported on the same date with modifier 25 appended to the E/M code. This may allow for additional reimbursement.

8. Historical information

CPT 98926 was added to the Current Procedural Terminology system on January 1, 1994. The code underwent a change on January 1, 2009, with the description being updated to specify the involvement of three to four body regions. There have been no further updates to the code since then.

9. Examples

1. A healthcare provider performing osteopathic manipulative treatment on a patient’s head, neck, and spine to address chronic migraines.
2. A provider applying controlled manual pressure on a patient’s chest, abdomen, and extremities to alleviate symptoms of asthma.
3. A healthcare professional performing osteopathic manipulative treatment on a patient’s hip, spine, and extremities to address carpal tunnel syndrome.
4. A provider applying pressure on a patient’s abdomen, chest, and head to alleviate sinus disorders.
5. A healthcare provider performing osteopathic manipulative treatment on a patient’s abdomen, chest, and hip to alleviate menstrual discomfort.