CurrentUnitedHealthcarePolicy CSNCT0541.07

Manipulative Therapy (for North Carolina Only)

Policy governing manipulative therapy services (including chiropractic and osteopathic manipulative treatment) for members in North Carolina; aligns coverage rationale to the North Carolina Medicaid Chiropractic Services clinical coverage policy and lists applicable codes. Affects providers billing UnitedHealthcare for NC members.

Policy Summary

PayerUnitedHealthcare

PolicyManipulative Therapy (for North Carolina Only)

Policy CodePolicy CSNCT0541.07

Change TypeRoutine review — no material change

Effective DateJun 1, 2026

Next Review DateN/A

Key ActionConfirm member meets medical necessity criteria per the North Carolina Medicaid Clinical Coverage Policy, Chiropractic Services (1F) before billing.

SourceLink

POLICY UPDATE CHANGES

Routine review; no change to coverage guidelines.

North Carolinageographic applicability

CSNCT0541.07policy identifier

2026-06-01effective date

NC Medicaid 1Fcoverage reference

Coverage Criteria

Coverage contingent on NC Medicaid Chiropractic Services criteria

Covered when medical necessity criteria per North Carolina Medicaid Clinical Coverage Policy, Chiropractic Services (1F) are met.

NC Medicaid criteria required: Member must meet the medical necessity clinical coverage criteria in the North Carolina Medicaid (Division of Health Benefits) Clinical Coverage Policy, Chiropractic Services (1F).

See referenced NC Medicaid policy for detailed elements.

Codes in the Applicable Codes list that are marked with an asterisk are not on the State of North Carolina Medicaid Fee Schedule and therefore may not be covered by the State of North Carolina Medicaid Program. Listing a code in this policy does not guarantee coverage or payment; benefit coverage is determined by federal, state, or contractual requirements.

This policy defers medical necessity decisions to the North Carolina Medicaid (Division of Health Benefits) Clinical Coverage Policy, Chiropractic Services (1F). For medical necessity clinical coverage criteria, providers must refer to that NC Medicaid policy because this UnitedHealthcare policy does not itself list independent medical necessity criteria.

Coding and Code Definitions

Referenced OMT and CMT CodesCPT

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.

Covered CPT Code ListedCPT

98943

Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions.

HCPCS CodeHCPCS

S8990

Physical or manipulative therapy performed for maintenance rather than restoration.

OMT body regions (98925–98929)

98925OMT — 1-2 body regions

98926OMT — 3-4 body regions

98927OMT — 5-6 body regions

98928OMT — 7-8 body regions

98929OMT — 9-10 body regions

CMT spinal regions (98940–98942)

98940CMT — spinal, 1-2 regions

98941CMT — spinal, 3-4 regions

98942CMT — spinal, 5 regions

Provider Actions & Billing Guidance

Prior Authorization

Check governing benefit documents

Check the governing benefit documents (federal, state, and contractual requirements) before relying on this policy. Benefit coverage may differ from the standard UnitedHealthcare Medical Policy; in the event of a conflict, the federal, state, or contractual requirements for benefit plan coverage govern. Verify any applicable prior authorization, coverage mandates, or exclusions in the member’s plan documents.

Check federal, state, and contractual plan documents for coverage requirements and prior authorization rules.
If there is a conflict between this policy and the member’s benefit contract, the benefit contract prevails.

Billing Rule

Coding inclusion is not coverage

The presence of procedure or diagnosis codes in this policy is for reference only and does not guarantee that a service is a covered benefit or that payment will be made. Inclusion of a code does not imply any right to reimbursement. Always confirm coverage and reimbursement by reviewing the member’s specific benefit plan and applicable laws.

Code lists are informational only — check member benefits for coverage and payment.
Coding inclusion is not a determination of medical necessity or reimbursement.

Step Therapy

Step therapy

There are no step therapy requirements specified within this policy. If the member’s plan imposes step therapy or other utilization management requirements, follow the member’s benefit plan rules.

This policy does not establish any step therapy protocols.
Confirm any step therapy requirements in the member’s benefit documents before initiating treatment.

Background

Background: This policy governs manipulative therapy services for UnitedHealthcare members in North Carolina and aligns its coverage rationale to the North Carolina Medicaid Clinical Coverage Policy, Chiropractic Services (1F). The purpose of the policy is to list applicable procedure codes and indicate that coverage is contingent on meeting the NC Medicaid clinical criteria; it does not redefine medical necessity. Providers should consult the referenced NC Medicaid policy for the detailed clinical elements that determine coverage.

Definitions

CPT 98943

98943Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions

OMT codes (98925–98929)

98925Osteopathic manipulative treatment (OMT); 1-2 body regions involved

98926Osteopathic manipulative treatment (OMT); 3-4 body regions involved

98927Osteopathic manipulative treatment (OMT); 5-6 body regions involved

98928Osteopathic manipulative treatment (OMT); 7-8 body regions involved

98929Osteopathic manipulative treatment (OMT); 9-10 body regions involved

CMT codes (98940–98942)

98940Chiropractic manipulative treatment (CMT); spinal, 1-2 regions

98941Chiropractic manipulative treatment (CMT); spinal, 3-4 regions

98942Chiropractic manipulative treatment (CMT); spinal, 5 regions