Only one OMT service can be reimbursed per day. (Submitting the same OMT code twice in the same day will result in the service being denied/rejected.)
- When treating multiple body regions, use the code for the total number of regions treated. For example, OMT for cervical, thoracic, and lumbar regions must be submitted as CPT code 98926.
- Treatment of three additional body regions on the same day must be submitted as CPT code 98927, and not CPT code 98926 twice
An E/M service may be submitted on the same day as OMT if the service is significant and separately identifiable from the OMT, and CPT modifier 25 is used.
- Examples could include the first visit at which a patient is examined, or when another condition is being treatment for which OMT is not provided, or when a significant change in the patient's condition warrants an additional evaluation
- An E/M service should also be reported if work is done that is not included in the OMT (e.g., change of medications, review of additional or new data, or the ordering of laboratory imaging studies, x-rays, or additional studies)