Summary & Overview
CPT 98926: Manual Therapy, Controlled Pressure, 3–4 Body Regions
CPT code 98926 denotes a manual therapy procedure involving controlled manual pressure applied to three to four body regions to address somatic and nonsomatic disorders. Nationally, this code captures a common hands-on therapeutic modality used by clinicians in rehabilitation, physical medicine, and related outpatient settings to relieve pain and improve function. Accurate use of this code affects claims processing, coverage determinations, and payment for manual therapy services across payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes how CPT code 98926 is positioned within clinical practice, typical sites of service, and payer coverage patterns where available. Readers will find benchmarks and comparative context for utilization, common billing practices, and the clinical scenarios in which a three- to four-region manual therapy service is documented. Where payer-specific policies and coverage rules exist, the analysis highlights coverage considerations and potential documentation expectations.
The content also provides practical context for clinicians and billing staff about service definitions and typical clinical indications for CPT code 98926, enabling clearer coding and administrative workflows. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 98926 describes a manual therapy service in which the provider performs controlled manual pressure in three to four body regions to treat somatic and nonsomatic disorders. This service is a form of hands-on therapeutic intervention aimed at reducing pain, improving mobility, and addressing musculoskeletal and related functional issues.
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Service type: Manual therapy (controlled manual pressure across multiple body regions)
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Typical site of service: Outpatient clinic, physician office, physical therapy or rehabilitation setting, or other ambulatory care locations where hands-on musculoskeletal treatment is provided.
Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient presents to a physical medicine clinic with a 6-week history of persistent myofascial neck and upper back pain after a motor vehicle collision. The patient reports focal trigger points, reduced range of motion, and referred shoulder pain limiting activities of daily living. The clinician (certified massage therapist or licensed physical therapist under physician supervision, or an appropriately credentialed physician assistant) performs a focused manual therapy visit consisting of controlled manual pressure applied to three to four distinct body regions (neck paraspinals, upper trapezius, scapular musculature, and upper thoracic paraspinals) to treat somatic dysfunction and associated soft-tissue pain. Documentation includes start and stop times, body regions treated, objective findings (tender points, range-of-motion deficits), patient tolerance, and a treatment plan. Typical site of service is an outpatient clinic, physical medicine/rehabilitation clinic, or ambulatory surgery center for follow-up conservative management. The visit may occur after an initial evaluation (separately reported) and may be billed for recurrent visits when manual therapy is provided to address ongoing somatic or nonsomatic disorders.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the same day | Use when a distinct evaluation and management visit is provided and documented in addition to the manual therapy service |