Osteopathic manipulative treatment performed by a physician on one or two body regions, including a brief pre-treatment assessment.
- Medicare
- $32.40
- Work RVU
- 0.45
- Global, days
- 0
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Each body region treated
- Somatic dysfunction findings for each region
- OMT technique used
- Diagnosis codes matching the regions (M99 series)
- Patient response
- Separate E/M documentation if billed with modifier 25
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
98925 is osteopathic manipulative treatment (OMT) to one or two body regions. It is billed by a DO or other physician trained in OMT. The 10 recognized regions include head, cervical, thoracic, lumbar, sacral, pelvic, rib cage, abdomen and viscera, upper extremity, and lower extremity. The code has a 0-day global.
DO sports medicine and nonoperative spine physicians in ortho groups use it for mechanical neck and back pain, sacroiliac dysfunction, and rib dysfunction. Treating the cervical and thoracic regions is two regions, which is still 98925. Three or four regions moves to 98926.
The pre-manipulation assessment is included. A separate E/M on the same day needs modifier 25 and has to stand on its own, such as evaluation of a new knee complaint or a decision about imaging. Payers deny when region count is unclear or the somatic dysfunction diagnosis codes (M99 series) do not match the regions treated. List each region, the dysfunction found, and the technique used.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (0.45) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (0.97) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.45 |
| Practice expense RVU | 0.49 |
| Malpractice RVU | 0.03 |
| Total RVU | 0.97 |
| Medicare national rate | $32.40 |
| Global period | 0 days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $32.40 |
HOPD (APC 5811) Hospital outpatient department | $22.06 |
Common denial reasons
The recurring reasons claims for CPT 98925 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Region count does not match documentation
- E/M billed without modifier 25 or without separate work
- Somatic dysfunction diagnosis missing or mismatched to regions
- Billed by a provider not credentialed for OMT
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01How many regions does 98925 cover?
02Can I bill an E/M with 98925?
03What diagnosis codes support OMT?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe lists each region treated, the dysfunction found, and the technique, and keeps any separate E/M work distinct, so region count and modifier 25 both hold up.
See how Mira captures CPT 98925 documentation