Billing and Coding: Osteopathic Manipulative Treatment

Osteopathic manipulative treatment (OMT) is covered when medically necessary, performed by a qualified physician, and supported by history and physical exam documentation of somatic dysfunction in one or more regions. E&M services may be billed separately with modifier -25 only if the E&M is a significant, distinct service beyond routine pre/post OMT care and is properly documented; routine follow-up OMT does not justify a separate E&M unless a new condition or substantial change in condition occurs. Coverage is denied when documentation of somatic dysfunction or the required distinct E&M documentation is absent.

"Osteopathic manipulative treatment (OMT) is covered when medically necessary and performed by a qualified physician for patients whose history and physical examination document somatic dysfunction ..."

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