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See a sample rate comparisonCPT 98926 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Osteopathic Manipulative Treat, Osteopathic Manipulative Treatment (Omt) Three Tofour Bodyregions Involved Osteopathic Manipulati Ve Treatment (Omt) Three To Four Body
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Osteopathic Manipulative Treatment Procedures |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service GP - Services delivered under an outpatient physical therapy plan of care |
| Complexity Level | Low |
| Medicare Fee Schedule | $46.09 national non-facility rate (2026) · View Medicare rates for 98926 |
| Medicaid Fee Schedule | $37.395 median of the 8 states in the free preview · View Medicaid rates for 98926 |
National average reimbursement for CPT 98926 by major payers:
$45.07
$56.00
$49.61
$55.49
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CPT 98926
5 of 25 sample ratesHigher to lower in this preview
Ravi Ramasamy
The Association Of Chrmc And University Physicians
$108.27Published rateDavid Hanrahan
Loyola University Medical Center
$88.77Published rateEwa Bieber
$81.55Published rateSuraya Kawadry
Loyola University Medical Center
$73.62Published rateMelissa Wagner-Schuman
$33.72Published rate
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See a sample payer proposalCPT 98926 vs. Other Osteopathic Manipulative Treatment Procedures Codes
The CPT 98926 code is part of the Medicine Services and Procedures services used for Osteopathic Manipulative Treatment Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 98926 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 98925-CPT | Low | Osteopathic Manipulative Treat, Osteopathic Manipulative Treatment (Omt) One To Two Bodyregions Involved Osteopathic Manipulative Treatment (Omt) One To Two Body |
| 98926-CPT | Low | Osteopathic Manipulative Treat, Osteopathic Manipulative Treatment (Omt) Three Tofour Bodyregions Involved Osteopathic Manipulati Ve Treatment (Omt) Three To Four Body |
| 98927-CPT | Low | Osteopathic Manipulative Treat, Osteopathic Manipulative Treatment (Omt) Five To Six Bodyregions Involved Osteopathic Manipulativetreatment (Omt) Five To Six Body |
| 98928-CPT | Low | Osteopathic Manipulative Treat, Osteopathic Manipulative Treatment (Omt) Seven Toeightbody Regions Involved Osteopathic Manipulat Ive Treatment (Omt) Seven To Eight |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 98926. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 98926 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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Frequently Asked Questions
To get an estimate for a medical procedure, you can start by contacting your healthcare provider's billing department. They can often provide a good faith estimate. For more detailed information based on specific CPT codes and your location, you can also use tools like Payerprice's fee schedule lookup tool, which can help you research potential costs before your appointment.
CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services to payers for reimbursement. They are crucial because they ensure consistent reporting of medical services, which in turn helps in determining the cost of a procedure and what your insurance might cover.
To understand your insurance coverage for a specific medical service, the best first step is to contact your insurance provider directly. They can explain your benefits, deductible, co-pays, and co-insurance for the service you're considering. Additionally, you can use tools like Payerprice to research the potential costs associated with specific CPT codes in your area, which can help you anticipate your out-of-pocket expenses, even before discussing coverage with your insurer.
Yes, for looking up medical service prices based on CPT codes and specific locations, Payerprice offers a fee schedule lookup tool. This tool allows users to search with a CPT code and their location to find relevant pricing information, helping them understand potential costs for various medical procedures.
A fee schedule is a complete listing of fees used by health plans to pay physicians and/or other providers. It specifies the maximum dollar amount that the plan will reimburse for each covered service. Your individual payment responsibility (co-pay, deductible, co-insurance) is then calculated based on this agreed-upon fee schedule and your specific insurance plan's benefits. Understanding fee schedules can help you anticipate costs, and tools like Payerprice can provide insights into these schedules based on CPT codes and location.