Demystifying Documentation and Billing for Osteopathic Manipulative Treatment


Osteopathic manipulative treatment is indicated for several common ailments, but documenting and coding it can be daunting for beginners. Here's how it's done.

Fam Pract Manag. 2021 May-June;28(3):18-22.

Author disclosures: no relevant financial affiliations disclosed.

Osteopathic manipulative treatment (OMT) is a procedure used mainly by doctors of osteopathic medicine (DOs) for a range of medical conditions. For instance, there's evidence OMT can decrease pain and analgesic use in patients with chronic low-back pain and pregnancy-related low-back pain, can ease postoperative gastrointestinal issues, and may improve outcomes for elderly patients hospitalized with pneumonia.14 Because of the commonality of these conditions, and others for which OMT is indicated, some allopathic physicians (MDs) have also sought training in this skill.

But there is often confusion about how the procedure should be billed and reimbursed, particularly among physicians who are new to it. Institutional coding and compliance departments have used surgical compliance codes to determine that OMT has a surgical code of zero, which is considered a minor procedure. That means it can be billed the same day as an evaluation and management (E/M) office visit. But Centers for Medicare & Medicaid Services (CMS) guidelines for precepting procedures indicate that a minor procedure takes less than five minutes. It always takes longer than five minutes to do an evaluation and OMT treatment (though there does not need to be long-term follow-up as part of a global encounter as in other surgical procedures), so this gets complicated. Insurance companies often inappropriately bundle the OMT code with the E/M service or eliminate the E/M code altogether.5 Not receiving appropriate reimbursement for OMT could lead physicians to no longer offer this beneficial service to their patients. That would be unfortunate, in part because OMT could be an alternative to opioids for chronic pain, reducing the billions of dollars that opioid misuse costs the U.S. economy every year.6

This article seeks to cut through the confusion and clarify documentation and billing requirements for OMT so more patients and health systems can benefit from it.


  • Osteopathic manipulative treatment (OMT) is indicated for a variety of conditions, but physicians may be confused about how to code and document OMT to get properly reimbursed.

  • OMT can often be performed — and billed — with an evaluation and management (E/M) office visit.

  • Documentation should support the medical necessity for the OMT, including identifying the somatic dysfunctions to be treated, and should also include the number of body regions treated, the technique, and the outcome.


OMT is billed based on the number of body regions treated. For purposes of OMT, there are 10 body regions, with ICD-10 codes corresponding to the dysfunction of each region. There are then five CPT codes that can be used depending on the number of regions treated. (See “OMT Coding.”) Only one


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Dr. James is an assistant professor in the University of Wisconsin School of Medicine and Public Health's Department of Family Medicine and Community Health. She is director of osteopathic education for the Statewide Osteopathic Collaborative in Wisconsin and a member of the Accreditation Council for Graduate Medical Education's Osteopathic Principles Committee....

Dr. Johannes is an instructor of family medicine for the Mayo Clinic College of Medicine and precepts at Mankato Family Medicine Residency in Minnesota.

Cheryl Novak is a former coding specialist in the University of Wisconsin School of Medicine and Public Health's Department of Family Medicine and Community Health and the past president of the Madison (Wisc.) chapter of the American Academy of Professional Coders.

Author disclosures: no relevant financial affiliations disclosed.


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1. Hensel KL, Buchanan S, Brown SK, Rodriguez M, Cruser dA. Pregnancy research on osteopathic manipulation optimizing treatment effects: the PROMOTE study. Am J Obstet Gynecol. 2015;212(1):108.e1–9....

2. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514–530.

3. Baltazar GA, Betler MP, Akella K, Khatri R, Asaro R, Chendrasekhar A. Effect of osteopathic manipulative treatment on incidence of postoperative ileus and hospital length of stay in general surgical patients. J Am Osteopath Assoc. 2013;113(3):204–209.

4. Noll DR, Degenhardt BF, Morley TF, et al. Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial. Osteopath Med Prim Care. 2010;4:2.

5. Snider KT, Jorgensen DJ. Billing and coding for osteopathic manipulative treatment. J Am Osteopath Assoc. 2009;109(8):409–413.

6. Florence CS, Zhou C, Luo F, Xu L. The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care. 2016;54(10):901–906.

7. Millette K. Countdown to the E/M coding changes. Fam Pract Manag. 2020;27(5):29–36.

8. Your guide to osteopathic billing and coding resources. American Osteopathic Association. Accessed March 11, 2021.


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