Policy/Procedure Number: MCUP3130 / Lead Department: Health Services
Policy/Procedure Title: Osteopathic Manipulation Therapy / ☒External Policy
☐ Internal Policy
Original Date: 06/17/2015
Effective Date: 10/01/2015 / Next Review Date: 09/12/2019
Last Review Date: 09/12/2018
Applies to: / ☒ Medi-Cal / ☐ Employees
Policy/Procedure Number: MCUP3130 / Lead Department: Health Services
Policy/Procedure Title:Osteopathic Manipulation Therapy / ☒External Policy
☐Internal Policy
Original Date: 06/17/2015
Effective Date: 10/01/2015 / Next Review Date:09/12/2019
Last Review Date:09/12/2018
Applies to: / ☒Medi-Cal / ☐ Employees
Reviewing Entities: / ☒ IQI / ☐ P & T / ☒ QUAC
☐OPerations / ☐Executive / ☐Compliance / ☐Department
Approving Entities: / ☐BOARD / ☐COMPLIANCE / ☐FINANCE / ☒ PAC
☐ CEO / ☐COO / ☐Credentialing / ☐ DEPT. DIRECTOR/OFFICER
Approval Signature: Robert Moore, MD, MPH, MBA / Approval Date:09/12/2018
  1. RELATED POLICIES:

N/A

  1. IMPACTED DEPTS:
  2. Health Services,
  3. Member Services
  4. Claims
  1. DEFINITIONS:
  2. Osteopathic medicine is a branch of the medical profession in the United States, whose physicians are known as Doctors of Osteopathy (DO).
  3. Osteopathic physicians are trained in Osteopathic Manipulative Treatment (OMT), also known as Osteopathic Manipulative Medicine (OMM), a core set of manual manipulative techniques used to treat somatic dysfunction.
  1. ATTACHMENTS:
  2. N/A
  1. PURPOSE:
  1. POLICY / PROCEDURE:
  1. OMT services should only be provided by physicians skilled, trained and experienced in providing these services. This includes Doctors of Osteopathic Medicine, but may include other licensed health care providers who complete supplementary training in this area.
  2. No treatment authorization is required to perform OMT, if it is performed by a primary care clinician credentialed with PHC, or a Doctor of Osteopathic Medicine credentialed by PHC as a specialist in osteopathy. Non-credentialed providers will not be eligible for payment for OMT.
  3. Coverage limitations. Only one OMT service should be billed per day. A maximum of 4 treatments may be billed per calendar month.
  4. Codes covered. The following CPT® codes are covered under this OMT policy:
  5. 98925 Osteopathic manipulative treatment (OMT); 1-2 body regions involved
  6. 98926 Osteopathic manipulative treatment (OMT); three to four body regions involved
  7. 98927 Osteopathic manipulative treatment (OMT); five to six body regions involved
  8. 98928 Osteopathic manipulative treatment (OMT); seven to eight body regions involved
  9. 98929 Osteopathic manipulative treatment (OMT); nine to ten body regions involved
  10. OMT is a proven medical therapeutic option for treatment of musculoskeletal disorders, including acute and chronic lower back pain.
  11. OMT is unproven and not medically necessary for treatment of:
  12. The patient’s condition has returned to the pre-symptom state.
  13. Little or no improvement is demonstrated within 30 days of the initial visit despitemodification of the treatment plan.
  14. Concurrent chiropractic manipulative therapy, for the same or similar condition, provided by anotherhealth professional whether or not the healthcare professional is in the same professionaldiscipline.
  15. Manipulative therapy under anesthesia.
  16. Non-musculoskeletal disorders (e.g. asthma, otitis media, infantile colic, etc.)
  17. Prevention/maintenance/custodial care
  18. Internal organ disorders (e.g., gallbladder, spleen, intestinal, kidney, heart or lung disorders)
  19. Temporomandibular Joint (TMJ) Disorder
  20. Scoliosis correction
  21. Craniosacral therapy (cranial manipulation)
  22. Manipulative services that utilize nonstandard techniques such as applied kinesiology technique, network and neural organizational technique
  23. All OMT services conducted should be documented in the medical record, including the diagnosis, any disability that is present, the treatment used, the length of the treatment, and the effectiveness of the treatment.
  1. REFERENCES:
  2. Spinal Manipulative therapy for chronic low-back pain. Cochrane abstract. January 31, 2013
  3. Spinal Manipulative therapy for acute low-back pain. Cochrane abstract. December 12, 2012
  1. DISTRIBUTION:
  2. PHC Provider Manual
  3. PHC Department Directors
  1. POSITION RESPONSIBLE FOR IMPLEMENTING PROCEDURE:Senior Director, Health Services
  1. REVISION DATES:05/18/16; 05/17/17; *09/12/18

*Through 2017, Approval Date reflective of the Quality/Utilization Advisory Committee meeting date. Effective January 2018, Approval Date reflects that of the Physician Advisory Committee’s meeting date.

PREVIOUSLY APPLIED TO:N/A

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Inaccordance with theCalifornia Healthand SafetyCode,Section 1363.5,this policywasdevelopedwith involvement from activelypracticinghealth care providersandmeetstheseprovisions:

  • Consistentwith sound clinicalprinciplesand processes
  • Evaluatedand updated atleast annually
  • Ifusedas thebasis ofadecision to modify, delayordenyservices ina specific case, thecriteria will be disclosedto the provider and/orenrollee upon request

The materials provided areguidelinesusedbyPHC to authorize, modifyor denyservices forpersonswithsimilar illnesses or conditions. Specific care andtreatment mayvarydependingonindividualneedand the benefitscovered underPHC.

PHC’s authorization requirements comply with the requirements for parity in mental health and substance use disorder benefits in 42 CFR 438.910.

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