CurrentUnitedHealthcarePolicy CS076KS.03

Manipulative Therapy (for Kansas Only)

State-specific UnitedHealthcare medical policy for manipulative therapy in Kansas, covering osteopathic manipulative therapy (OMT) and referencing chiropractic coverage to the Kansas Medical Assistance Program. Defines medically necessary and nonmedically necessary indications and lists applicable procedure codes and clinical evidence summaries.

Policy Summary

PayerUnitedHealthcare

PolicyManipulative Therapy (for Kansas Only)

Policy CodePolicy CS076KS.03

Change TypeDefinitions removed; informational evidence updates

Effective DateJun 1, 2026

Next Review Date

Key ActionDocument that OMT is being provided for a Musculoskeletal Disorder to meet the policy's medically necessary condition; services for unproven indications may be considered not medically necessary.

POLICY UPDATE CHANGES

Removed definition of 'Upledger Technique' from Definitions.

Updated Supporting Information, Description of Services, Clinical Evidence, and References sections to reflect the most current information.

1State-specific policy (Kansas)

1Primary covered indication: Musculoskeletal Disorders

6Explicitly not medically necessary examples

low-to-moderateEvidence quality

Observed benefit timeframe

Coverage Summary

This is a Kansas-specific UnitedHealthcare medical policy on Manipulative Therapy (effective June 1, 2026) that covers osteopathic manipulative therapy (OMT) for Musculoskeletal Disorders as the primary medically necessary indication and lists other indications considered unproven or not medically necessary. The policy is state-specific and applies only to Kansas.

The policy stance is mixed: OMT is considered proven and medically necessary for treating Musculoskeletal Disorders, while many other indications (including craniosacral therapy, nonstandard techniques, and a range of nonmusculoskeletal conditions) are listed as unproven or not medically necessary. Definitions, applicable procedure codes, and evidence summaries are provided.

State-specific note: chiropractic manipulative therapy coverage criteria and billing are delegated to the Kansas Medical Assistance Program; for chiropractic coverage the policy directs providers to the Kansas Medical Assistance Program: Chiropractic Fee-For-Service Provider Manual.

Sentinel: chiropractic coverage details are handled by the Kansas Medical Assistance Program (see Kansas chiropractic fee-for-service manual referenced in the policy).

Policy summary (compact)

State-specific policyKansas

Primary covered indicationMusculoskeletal Disorders

Examples of not medically necessary indications (count)6

Evidence qualitypredominantly low-to-moderate

Observed benefit timeframeshort-term

Overall evidence conclusionno high-quality consistent positive evidence for nonmusculoskeletal disorders

Medical-Necessity / Coverage Rationale

For coverage criteria for chiropractic Manipulative Therapy, refer to the Kansas Medical Assistance Program: Chiropractic Fee-For-Service Provider Manual. Osteopathic Manipulative Therapy (OMT) is considered proven and medically necessary for treating Musculoskeletal Disorders when the criteria below are met. OMT is unproven and not medically necessary for indications outside of Musculoskeletal Disorders due to insufficient evidence of efficacy.

ALL of the following

This policy only applies to Kansas.
For coverage criteria for chiropractic Manipulative Therapy, refer to the Kansas Medical Assistance Program: Chiropractic Fee-For-Service Provider Manual. Note: follow the Kansas Medical Assistance Program: Chiropractic Fee-For-Service Provider Manual for chiropractic coverage determinations.
Osteopathic Manipulative Therapy (OMT) is proven and medically necessary for treating Musculoskeletal Disorders (injuries or conditions that originate from joints, muscles, ligaments, discs, or other soft tissues in the spine or limbs producing clinically relevant symptoms and functional limitations).

Clinical Evidence and Background

Manipulative Therapy is defined as the therapeutic application of manual pressure or force in which the practitioner moves or manipulates one or more parts of the individual's body; the policy explicitly includes OMT and chiropractic/manual therapies and describes nonstandard techniques such as craniosacral therapy and applied kinesiology.

The evidence summary in the policy draws on multiple RCTs, systematic reviews, and meta-analyses across conditions (back, neck, shoulder, elbow/wrist/hand, scoliosis, and others). The American Osteopathic Association (AOA) characterizes evidence for OMT in chronic low back pain as weak and based on low-quality studies and recommends larger low-bias RCTs.

IFOMPT/IOPTP pediatric guidance is summarized: spinal mobilization/manipulation may be appropriate in adolescents for certain musculoskeletal conditions and spinal mobilization in children; it is not recommended for infants or for nonmusculoskeletal pediatric conditions. The policy notes that the FDA treats manipulative and craniosacral therapy as procedures not subject to FDA regulation (informational only).

Overall, the policy concludes evidence is mixed, predominantly low-to-moderate quality, with calls for larger, higher-quality trials.

Clinical evidence conclusions (informational summaries)

Summaries of available evidence and guideline positions:

ALL of the following

Coding

OMT / CMT CPT codes (reference only)CPT

98925	Osteopathic manipulative treatment (OMT); 1-2 body regions involved.
98926	Osteopathic manipulative treatment (OMT); 3-4 body regions involved.
98927	Osteopathic manipulative treatment (OMT); 5-6 body regions involved.
98928	Osteopathic manipulative treatment (OMT); 7-8 body regions involved.
98929	Osteopathic manipulative treatment (OMT); 9-10 body regions involved.
98940	Chiropractic manipulative treatment (CMT); spinal, 1-2 regions.
98941	Chiropractic manipulative treatment (CMT); spinal, 3-4 regions.
98942	Chiropractic manipulative treatment (CMT); spinal, 5 regions.
98943	Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions.

Maintenance therapy codeHCPCS

S8990

Physical or manipulative therapy performed for maintenance rather than restoration

Provider Actions & Documentation Requirements

Documentation Required

Document OMT for Musculoskeletal Disorder (codes 98925-98929, 98940-98943, S8990)

Document that OMT is being provided for a Musculoskeletal Disorder to satisfy the policy's medically necessary condition. Include the affected procedure codes when documenting: 98925–98929, 98940–98943, and S8990.

Documentation Required

Follow Kansas Chiropractic Fee-For-Service Provider Manual for CMT coverage and billing

Providers must follow the Kansas Medical Assistance Program: Chiropractic Fee-For-Service Provider Manual for chiropractic manipulative therapy coverage criteria and billing. Note that chiropractic coverage determinations are delegated to the Kansas Medicaid manual—refer to that manual for rules and billing instructions.

Chiropractic coverage is delegated—use the Kansas manual for coverage and billing guidance.

Definitions

Manipulative Therapy: defined as the therapeutic application of manual pressure or force in which the practitioner moves or manipulates one or more parts of the individual's body to achieve and maintain health; includes osteopathic manipulative treatment, manual therapy, chiropractic treatments, physical therapy, and massage therapy.

Musculoskeletal Disorders: injuries or conditions originating from joints, muscles, ligaments, discs, or other soft tissues in the spine or limbs producing symptoms (e.g., pain, numbness) and functional limitations.

OMT (Osteopathic Manipulative Treatment): osteopathic manipulative therapy/medicine provided by osteopathic practitioners as described throughout the policy (examples and evidence summaries provided).

SMT (Spinal Manipulative Therapy): spinal manipulation techniques used in trials and systematic reviews for back, neck, and related conditions.

MMT (Manual and Manipulative Therapy): umbrella term for hands-on therapies (mobilization, manipulation, soft-tissue techniques) used across musculoskeletal conditions.

CMMT (Craniomandibular Manual Therapy): manual therapy applied to craniomandibular structures for temporomandibular disorders with limited and heterogeneous evidence.

CST (Craniosacral Therapy): described as a noninvasive osteopathic technique involving light touch to influence cranial rhythms; the policy considers CST unproven with insufficient high-quality evidence.

Upledger Technique: definition removed (06/01/2026) (listed in the policy as removed from Definitions).

Revision History

06/01/2026archived

Archived previous policy version CS076KS.02.

06/01/2026definition_removed

Removed definition of 'Upledger Technique' from Definitions.

06/01/2026informational_updateLatest

Updated Supporting Information, Description of Services, Clinical Evidence, and References sections to reflect the most current information.

Policy Summary

PayerUnitedHealthcare

PolicyManipulative Therapy (for Kansas Only)

Policy CodePolicy CS076KS.03

Change TypeDefinitions removed; informational evidence updates

Effective DateJun 1, 2026

Next Review Date

On This Page

OMT is unproven / not medically necessary for ALL other indications (including, but not limited to):

Nonmusculoskeletal disorders (e.g., asthma, otitis media, infantile colic, internal organ disorders).
Prevention, maintenance, or custodial care (including services predominantly for maintenance rather than restoration).
Craniosacral therapy (cranial manipulation / Upledger technique).
Temporomandibular joint disorder (TMD).
Scoliosis (as a primary indication for OMT).
Manipulative services that use nonstandard techniques (e.g., applied kinesiology, including the neural organizational technique, and the National Upper Cervical Chiropractic Association process).

This policy does not address manipulation under anesthesia; refer to the Medical Policy titled Manipulation Under Anesthesia (for Kansas Only).

Evidence limitations: Available evidence is insufficient for many nonmusculoskeletal indications and for numerous nonstandard techniques. Providers should discuss evidence limitations with patients and obtain informed consent that includes the experimental or unproven nature of the proposed service when applicable.

Research need: Continued high-quality research (larger randomized controlled trials, active comparators, and longer-term follow-up) is needed to clarify the effectiveness of OMT for conditions beyond musculoskeletal disorders and to assess nonstandard techniques.

Documentation Required

Distinguish OMT indications

Document OMT indication and coding. Clearly document that osteopathic manipulative treatment is being provided for a Musculoskeletal Disorder. Services provided for unproven or not medically necessary indications may be denied.

Affected codes: CPT 98925, 98926, 98927, 98928, 98929; CPT 98940, 98941, 98942, 98943; HCPCS S8990
Instruction: Document that OMT is for a Musculoskeletal Disorder; if provided for unproven indications, document informed consent discussing evidence limitations and potential for denial.

Documentation Required

Refer to Kansas chiropractic manual for chiropractic coverage

Follow Kansas chiropractic manual for chiropractic coverage. Adhere to the Kansas Medical Assistance Program: Chiropractic Fee-For-Service Provider Manual for chiropractic manipulative therapy coverage rules and billing.

Instruction: Follow the Kansas Medical Assistance Program: Chiropractic Fee-For-Service Provider Manual for chiropractic coverage determinations and documentation requirements.

Craniosacral therapy (cranial osteopathy): systematic reviews and RCTs provide insufficient evidence to support reliability of diagnosis or clinical efficacy; most studies have high risk of bias and those with low risk of bias report only modest results possibly due to nonspecific effects.

Nonstandard manipulative techniques (e.g., applied kinesiology, National Upper Cervical Chiropractic Association technique, neural organizational technique): published peer-reviewed literature was not identified.

American Osteopathic Association: evidence for efficacy of osteopathic manipulative treatment (OMT) for chronic low back pain is considered weak, based on low-quality studies; AOA recommends larger low-bias RCTs and further research on mechanisms and cost-effectiveness.

IFOMPT/IOPTP pediatric guidance: spinal mobilization/manipulation may be appropriate in adolescents for certain musculoskeletal conditions and spinal mobilization in children; NOT recommended for infants or for nonmusculoskeletal pediatric conditions (list of nonmusculoskeletal pediatric conditions included).

FDA: Manipulative therapy and craniosacral therapy are procedures and not subject to FDA regulation; FDA approval alone is not a basis for coverage (informational only).

Key evidence-pattern takeaways and limitations link back to the definitions and evidence summaries: many trials and reviews report limited sample sizes, short follow-up, and substantial heterogeneity across interventions and outcomes.

The policy repeatedly notes a high risk of bias in many studies and emphasizes that the current literature often lacks standardized protocols, blinding, and long-term outcome data.

Providers are advised that these evidence limitations necessitate cautious interpretation of reported short-term benefits and that robust, well-powered RCTs with longer follow-up are needed to clarify efficacy and safety for many indications.

Evidence highlights

Chronic low back pain — RCTs/meta-analysesMultiple RCTs and meta-analyses show small-to-moderate short-term benefits; quality variable and heterogenous

Opioid-sparing associationVHA cohort (Lisi et al. 2025): chiropractic care linked to lower 1‑year opioid fills (13.2% vs 17.1%; HR ~0.74)

Scoliosis — insufficiency of evidenceAvailable evidence insufficient to consider manual therapy proven safe/effective for idiopathic scoliosis

Infantile colic — CST findingsSmall RCTs/meta-analyses show modest short-term reductions in crying hours; studies at risk of bias

Craniosacral therapy — physiologic signalHRV meta-analysis: moderate short-term increase in parasympathetic HF power but limited studies and bias

AOA assessment for OMT in chronic LBPAOA: evidence considered weak; larger low-bias RCTs recommended

Documentation Required

Evidence limitations and informed consent discussion (document uncertainty and consent)

Discuss with patients the limitations of the evidence: much of the literature has small samples, short follow-up, heterogeneity, and risk of bias, and long-term benefits are uncertain. Document the informed consent discussion in the record, including that evidence gaps exist and uncertainty about long-term benefit.

Documentation Required

Use in selected conditions with conditional benefit (document indication, protocol, outcomes)

When providing manual therapy/OMT for selected musculoskeletal conditions, document the indication, treatment protocol, and outcomes. The policy notes that manual therapy/OMT may provide short-term improvements (pain, function, ROM) for select musculoskeletal conditions (for example, lateral epicondyle pain; hip, knee, ankle OA; plantar heel pain; cervicogenic headache; some TMD protocols), but given variable evidence quality, record indication, protocol details, and response/outcomes.

Billing Rule

Use InterQual and plan-specific rules (verify federal/state/contractual requirements)

UnitedHealthcare uses InterQual for primary medical/surgical criteria; if InterQual lacks applicable criteria, use UnitedHealthcare Medical Policies approved by the Kansas Department of Health and Environment. Verify applicable federal, state, and contractual requirements when making coverage decisions.