Osteopathic manipulative treatment performed by a physician (usually a DO) across 7 to 8 separate body regions during a single encounter, based on documented somatic dysfunction in each region.
- Medicare
- $73.48
- Work RVU
- 1.18
- Global, days
- 0
- Region
- Multi-region
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 7 to 8 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
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
98928 reports osteopathic manipulative treatment (OMT) when the physician treats 7 or 8 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.
Seven or eight regions is uncommon in an orthopedic setting and draws audit attention. It fits patients with widespread dysfunction, for example after a motor vehicle collision with neck, thoracic, rib, lumbar, sacral, pelvic, and extremity complaints. If the note reads like a template, expect a records request.
Expect the E/M on the same date to get a second look. Modifier 25 is correct only when the note shows real evaluation work beyond picking regions to treat. The code has a 0-day global, so follow-up visits are billed on their own merits.
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 (1.18) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (2.2) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 1.18 |
| Practice expense RVU | 0.95 |
| Malpractice RVU | 0.07 |
| Total RVU | 2.2 |
| Medicare national rate | $73.48 |
| 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 | $73.48 |
HOPD (APC 5811) Hospital outpatient department | $22.06 |
Common denial reasons
The recurring reasons claims for CPT 98928 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 ↓
01When is CPT 98928 used?
02Does Medicare cover 98928?
03Can a chiropractor bill 98928?
04Why do payers audit 98928 so often?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe lists each treated region with its findings and technique, so the note clearly supports 7 to 8 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 98928 documentation