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OMT Billing Issues for E&M Service
with Modifier 25
It has come to our attention that E&M services provided on the same day as OMT continue to be targeted by many insurers including Regence. These payers are denying separate payments for the E&M service with modifier 25. In addition, some payers may only allow reimbursement for OMT once every 30 or 60 days. This is a troubling trend that appears to be happening in other states, not just in Washington. WOMA is taking a proactive approach to understand the scope of this issue and help address it.
If you provide OMT for your patients and have received denials for E&M services provided on the same day as OMT, we strongly encourage you to forward your denial letters (redacted to remove personal identifiers) to executivedirector@woma.org.
Please provide additional specifics if possible, such as:
Type of practice: e.g., private, employed, academic, etc.
The payers that are denying claims: e.g., Regence, Premera, Medicare, etc.
Payers without issues: '' ''
If appealed, how many were still denied: e.g., 30%, etc.
Other comments: e.g., impact, had to close down clinic, etc.
For OMT practices that do not bill insurance, we would also like to hear from you to understand why you have stopped participating in insurance. Your stories can help in our discussions about the administrative burden created by payers.
Thank you for your time and information!
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