CurrentPremera BluecrossPolicy N/A

Manipulation Services (Chiropractic and Osteopathic)

Defines how Premera Blue Cross applies limits, coding and reimbursement rules for chiropractic (CMT) and osteopathic (OMT) manipulation services billed on professional claim forms; applies to Premera and affiliated lines of business and products.

Policy Summary

PayerPremera Bluecross

PolicyManipulation Services (Chiropractic and Osteopathic)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionLimit CMT to one spinal code plus one extra‑spinal code and limit OMT to one manipulation code — one unit per code, per provider, per patient, per day.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

one spinal + one extra-spinalCMT limited to per patient per day

one unit per codeUnit limits per provider/patient/day

98940-98943CMT codes listed

98925-98929OMT codes listed

Modifier 25E&M billing allowance

Coverage and Reimbursement Rules

Policy Summary

PayerPremera Bluecross

PolicyManipulation Services (Chiropractic and Osteopathic)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionLimit CMT to one spinal code plus one extra‑spinal code and limit OMT to one manipulation code — one unit per code, per provider, per patient, per day.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Manipulation services coverage and bundling rules

Covered when the following unit limits, billing rules, and bundling criteria are met:

ALL of the following

CMT limited to one spinal code (one or more regions) AND one extra‑spinal code, one unit per code, per provider, per patient, per day.
Per Payment Policy
OMT limited to one manipulation code, one unit per code, per provider, per patient, per day.
Per Codes/Coding Guidelines

ALL of the following

CMT and OMT procedure codes include preservice (pre‑manipulative) assessment, intra‑service work and post‑service work; these services are considered included in the procedure reimbursement and not separately reportable as E&M in routine circumstances.
Exception: If the patient’s condition requires significant, separately identifiable E&M services beyond the preservice/intra/post‑service work included in the CMT or OMT service, the additional E&M may be reported separately with modifier 25 and documentation must support the additional services.

ALL of the following

Physical medicine / therapeutic services (e.g., CPT 97112, 97124, 97140) performed on the same date as CMT will be reimbursed only when performed on different anatomic (or extraspinal) regions than the CMT service.
When reimbursed concurrently, the therapeutic service must be appended with Modifier XS or Modifier 59 and the diagnosis must indicate a different anatomic region than the CMT service.
If the therapeutic service and the CMT service are rendered to the same anatomic region with the same diagnosis, the therapeutic service will be denied as included in the CMT service.

ALL of the following

When reporting separate E&M in conjunction with CMT/OMT, append modifier 25 to the E&M code.
Documentation must clearly support that the E&M was significant and separately identifiable beyond the assessment and work included in the manipulation procedure code.

ALL of the following

Units per day per provider: one unit per code per provider per patient per day for both CMT and OMT.

Procedure Codes and Unit Limits

Chiropractic manipulationsCPTCovered

98941	Chiropractic manipulative treatment (CMT); spinal, 3-4 regions
98940	Chiropractic manipulative treatment (CMT); spinal, 1-2 regions
98942	Chiropractic manipulative treatment (CMT); spinal, 5 regions
98943	Chiropractic manipulative treatment (CMT); extra spinal, 1 Or more regions

Osteopathic manipulationsCPTCovered

98926	Osteopathic manipulative treatment (OMT); 3-4 body regions involved
98925	Osteopathic manipulative treatment (OMT); 1-2 body regions involved
98927	Osteopathic manipulative treatment (OMT); 5-6 body regions involved
98929	Osteopathic manipulative treatment (OMT); 9-10 body regions involved
98928	Osteopathic manipulative treatment (OMT); 7-8 body regions involved

Physical Medicine and Rehabilitation therapeutic servicesCPT

97112	Therapeutic procedure, 1 Or more areas, each 15 minutes; neuromuscular reeducation of movement; balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities
97124	Therapeutic procedure, 1 or more areas; 15 minutes; massage, including effleurage, petrissage and/or tapotement
97140	Manual therapy techniques; mobilization/ manipulation, manual lymphatic drainage, manual traction, 1 or more regions, each 15 minutes

Units per day per provider

Units per code per provider per patient per dayOne unit per code per provider per patient per day for CMT and OMT

CMT daily limit detailCMT limited to one spinal code (one or more regions) and one extra‑spinal code, one unit per code, per provider, per patient, per day

OMT daily limit detailOMT limited to one manipulation code, one unit per code, per provider, per patient, per day

Scope of included workPreservice, intra‑service and post‑service assessment/work are included in the CMT and OMT procedure codes

Billing, Documentation, and Same-Day Service Rules

Billing Rule

Daily unit limits — CMT and OMT

The Plan limits CMT to one spinal code (one or more regions) and one extra-spinal code, one unit per code, per provider, per patient, per day. CMT codes include pre-manipulative assessment, intra-service work, and all post-service work; these elements are considered included in the CMT procedure reimbursement. Per CMS NPFS, CMT procedure codes are considered minor procedures and an E&M service on the same date is generally included in the procedure reimbursement and not reported separately.

Affected codes: CMT spinal and extra-spinal CPT codes (one spinal + one extra-spinal, one unit per code, per provider, per patient, per day).

Billing Rule

Billing E&M with modifier 25

If the patient's condition requires additional evaluation and management services that are significant and separately identifiable beyond the pre-service, intra-service, and post-service work included in CMT or OMT, the additional E&M may be reported separately using the appropriate office/outpatient E&M code appended with modifier 25. Documentation must clearly support the medical necessity and that the E&M is distinct from the work inherent to the manipulation service.

Report E&M on same date as CMT/OMT only with modifier 25 when the E&M is significant and separately identifiable.
Ensure documentation details what additional work was performed (history, exam, medical decision making) that exceeds the routine pre/intra/post-service work included in CMT/OMT.

Documentation Required

PM&R services on same date as CMT

Physical medicine therapeutic services performed on the same date as a CMT service will be reimbursed only when the services are performed on different anatomic (or extra-spinal) regions. The physical medicine therapeutic service code must be appended with modifier XS or modifier 59, and the diagnosis code for the therapeutic service must indicate a different anatomic region than the CMT.

If PM&R (physical medicine/therapeutic) service and CMT are on different anatomic regions (e.g., lumbar vs cervical), append modifier XS or 59 to the PM&R code and submit a diagnosis indicating the different region.
If the PM&R service and the CMT are rendered to the same anatomic location and diagnosis codes indicate the same region, the PM&R service will be denied as included in the CMT service.

Key Definitions

CMT (Chiropractic Manipulative Treatment)

DefinitionChiropractic Manipulative Treatment (CMT): manual treatment to influence joint and neurophysiological functions; includes pre‑manipulative patient assessment and intra‑service work

CodingReported using CPT codes 98940–98943

Anatomic regions includedSpinal regions (cervical, thoracic, lumbar, sacral, pelvic) and extraspinal regions (head excluding atlanto‑occipital, upper/lower extremities, rib cage excluding certain joints, abdomen)

Bundling rulePer CMS NPFS, CMT is a minor procedure and routine E&M on the same date is considered included unless a significant, separately identifiable E&M is documented

OMT (Osteopathic Manipulative Treatment)

DefinitionOsteopathic Manipulative Treatment (OMT): manual treatment reported by number of body regions involved; preservice and post‑service assessment/work included

CodingReported using CPT codes 98925–98929

Body regionsHead, cervical, thoracic, lumbar, sacral, pelvic, upper and lower extremities, rib cage, abdomen and viscera regions

Daily unit limitOne manipulation code, one unit per code, per provider, per patient, per day

Minor procedure (per CMS NPFS)

Definition (CMS NPFS minor procedure)Classified as a 'minor procedure' per CMS NPFS; an E&M on the same date is generally included in the procedure reimbursement

When separate E&M allowedA significant, separately identifiable E&M service above and beyond included preservice/post‑service work may be reported separately with modifier 25

Documentation requirementDocumentation must support the need for additional E&M services beyond those included in the procedure code

Implication for billingRoutine E&M not separately reportable with minor procedures unless modifier 25 criteria are met