NMM/OMTORIGINAL ARTICLE

Utilization and reimbursement trends of osteopathic manipulative treatment for Medicare patients: 2000–2019

Evan G. Starr, BS; Jacob F. Smith, BS; Romney B. Hanson, BS; Jonathan B. Woolstenhulme, BS; Andrew J. Roush, BS; Nathan B. Sperry, BS; Benjamin Wilde, DO; Amanda E. Brooks, PhD; and Isain Zapata, PhD
Notes and Affiliations
Notes and Affiliations

Received: August 17, 2022

Accepted: February 7, 2023

Published: March 31, 2023

  • Evan G. Starr, BS, 

    Rocky Vista University College of Osteopathic Medicine, Ivins, UT, USA

  • Jacob F. Smith, BS, 

    Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA

  • Romney B. Hanson, BS, 

    University of Colorado School of Medicine, Aurora, CO, USA

  • Jonathan B. Woolstenhulme, BS, 

    University of Utah School of Medicine, Salt Lake City, UT, USA

  • Andrew J. Roush, BS, 

    Rocky Vista University College of Osteopathic Medicine, Ivins, UT, USA

  • Nathan B. Sperry, BS, 

    Rocky Vista University College of Osteopathic Medicine, Ivins, UT, USA

  • Benjamin Wilde, DO, 

    Department of Clinical Sciences, Rocky Vista University College of Osteopathic Medicine, Billings, MT, USA

  • Amanda E. Brooks, PhD, 

    Office of Research and Scholarly Activity, Rocky Vista University College of Osteopathic Medicine, Ivins, UT, USA

  • Isain Zapata, PhD, 

    Department of Biomedical Sciences, Rocky Vista University College of Osteopathic Medicine, Parker, CO, USA

J Osteopath Med; 123(6): 309-315
Abstract

Context: Osteopathic manipulative treatment (OMT) has been established as a beneficial and noninvasive treatment option for multiple conditions. With the total number of osteopathic providers tripling and the subsequent increase in osteopathic physician representation, we would expect the clinical use of OMT to increase accordingly.

Objectives: To that end, we evaluated the utilization and reimbursement of OMT services among Medicare beneficiaries.

Methods: Current procedural terminology (CPT) codes 98925 to 98929 were accessed from the Center for Medicare and Medicaid Services (CMS) from 2000 to 2019. These codes indicate OMT treatment, 98925 (1–2 body regions treated), 98926 (3–4 body regions treated), 98927 (5–6 body regions treated), 98928 (7–8 body regions treated), and 98929 (9–10 body regions treated). Monetary reimbursement from Medicare was adjusted for inflation, and total code volume was scaled to codes per 10,000 beneficiaries to account for the increase in Medicare enrollment.

Results: Overall OMT utilization declined between 2000 and 2019 by 24.5%. A significant downward trend in the utilization of CPT codes for OMT involving fewer body regions (98925–98927) was observed, and was contrasted by a slight upward trend in the use of codes for more body regions (98928, 98929). The adjusted sum reimbursement of all codes decreased by 23.2%. Lower value codes showed a higher rate of decline, whereas higher value codes changed less dramatically.

Conclusions: We conjecture that lower remuneration for OMT has disincentivized physicians financially and may have contributed to the overall decline in OMT utilization among Medicare patients, along with a decreased number of residencies offering specific training in OMT, and increased billing complexity. In considering the upward trend of higher-value code usage, it is possible that some physicians are increasing the comprehensiveness of their physical assessment and associated OMT to reduce the overall financial impact of reimbursement cuts.

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