Osteopathic manipulative treatment performed by a physician (usually a DO) across 3 to 4 separate body regions during a single encounter, based on documented somatic dysfunction in each region.

3 sources ↓

Medicare: $46.09
Work RVU: 0.69
Global, days: 0
Region: Multi-region

Drawn from CMS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 3 cited references ↓

Each of the 3 to 4 body regions treated, named individually (for example cervical, thoracic, lumbar, sacral, pelvic, upper extremity)
Somatic dysfunction findings per region: tissue texture change, asymmetry, restricted motion, or tenderness
Technique used in each region, such as muscle energy, counterstrain, myofascial release, or HVLA
Patient tolerance and response after treatment
Somatic dysfunction ICD-10 codes (M99.0x) that match each treated region
If an E/M is billed the same day, a separate history, exam, and decision-making section beyond the pre-manipulation assessment

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

25 Significant separate E/M 59 Distinct service XU Modifier

What this code covers

Source · Editorial summary grounded in 3 cited references ↓

98926 reports osteopathic manipulative treatment (OMT) when the physician treats 3 or 4 body regions in one visit. The ten recognized regions are head, cervical, thoracic, lumbar, sacral, pelvic, lower extremities, upper extremities, rib cage, and abdomen/viscera. Count regions treated, not techniques used. Three techniques on the lumbar spine is still one region.

In an orthopedic or sports medicine group, this usually comes from a DO treating mechanical low back or neck pain that crosses neighboring regions, such as cervical, thoracic, and rib cage dysfunction after a lifting strain. It sits between 98925 (one or two regions) and 98927 (five or six).

The pre-manipulation assessment is part of the OMT payment. When the DO also works up a new or changed problem, bill the E/M with modifier 25 and write that portion so it stands on its own. OMT carries a 0-day global. Payers still deny the E/M when the only work was deciding where to manipulate.

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 (0.69) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (1.38) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	0.69
Practice expense RVU	0.65
Malpractice RVU	0.04
Total RVU	1.38
Medicare national rate	$46.09
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	$46.09
HOPD (APC 5811) Hospital outpatient department	$22.06

Common denial reasons

The recurring reasons claims for CPT 98926 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Region count in the note does not support the code level billed
M99.0x somatic dysfunction codes missing or not matching the treated regions
E/M billed same day without modifier 25 or without separately documented work
Rendering provider is not credentialed for OMT under that payer contract
Payer visit limits for manual therapy already reached for the benefit year

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 3 cited references ↓

01How many body regions does CPT 98926 cover?

98926 covers three or four body regions treated with OMT in one visit. Two regions goes to 98925 and five goes to 98927.

02Can an orthopedic practice bill 98926 with an E/M visit?

Yes, if the E/M is significant and separately identifiable from the routine pre-treatment assessment. Append modifier 25 to the E/M and document that work separately.

03What diagnosis codes support 98926?

Payers expect somatic dysfunction codes from M99.00 to M99.09 for each treated region, often alongside the underlying condition such as low back pain or cervicalgia.

04Does using several techniques on one region count as more regions?

No. Regions are anatomic. Multiple techniques on the lumbar spine still count as one region.

Sources & references

Editorial content was developed using the following public sources.

01CMS Physician Fee Schedule 2026
02
cms.gov
https://www.cms.gov/medicare/payment/fee-schedules/physician
03
cms.gov
https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits

Mira Scribe

Mira Scribe lists each treated region with its findings and technique, so the note clearly supports 3 to 4 regions. When the visit also covers a separate problem, that work lands in its own section to back up modifier 25.

See how Mira captures CPT 98926 documentation