Osteopathic manipulative treatment performed by a physician (usually a DO) across 5 to 6 separate body regions during a single encounter, based on documented somatic dysfunction in each region.

3 sources ↓

Medicare: $60.79
Work RVU: 0.94
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 5 to 6 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 ↓

98927 reports osteopathic manipulative treatment (OMT) when the physician treats 5 or 6 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.

Five or six regions usually means a broader pattern, such as a patient with chronic low back pain whose pelvis, sacrum, lumbar, thoracic spine, and a lower extremity all show restriction. Payers look harder at this level, so each region needs its own finding, not a single line saying the spine was treated.

Same-day E/M follows the usual OMT rule. The quick check before treatment is already paid in 98927. A separately identifiable problem, like a new knee effusion or a medication change, goes on the E/M with modifier 25. With a 0-day global, nothing carries forward past the visit.

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 (0.94) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (1.82) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	0.94
Practice expense RVU	0.82
Malpractice RVU	0.06
Total RVU	1.82
Medicare national rate	$60.79
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	$60.79
HOPD (APC 5811) Hospital outpatient department	$22.06

Common denial reasons

The recurring reasons claims for CPT 98927 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 regions does CPT 98927 require?

98927 is for five or six body regions treated with OMT in one encounter. The note should name each region and its findings.

02Why was 98927 downcoded to 98926?

Usually the note only supported three or four regions with specific findings. Reviewers count regions with documented dysfunction and treatment, not regions mentioned in passing.

03Is modifier 59 needed on 98927?

Not normally. Modifier 59 or XU is only used when an NCCI edit pairs OMT with another procedure, like a separate joint injection, that was truly distinct.

04What is the global period for 98927?

98927 has a 0-day global period. Only same-day services are bundled into it.

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 5 to 6 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 98927 documentation