How much does Medicare pay for CPT 98926?

Medicare allowed an average of $43.00 per service and paid $32.39 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $103.32, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 98926?

Osteopathic manipulative treatment, 3-4 body regions. It was billed 66,809 times to 18,891 Medicare beneficiaries by 532 providers in 2024.

Does 98926 pay differently in an office than a hospital?

Yes. The allowed amount averaged $43.22 in an office setting and $38.91 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 98926 most?

Family Practice, with 17,078 services from 261 clinicians. Next are Nurse Practitioner, Osteopathic Manipulative Medicine, Physical Medicine and Rehabilitation.

CPT 98926

Osteopathic manipulative treatment, 3-4 body regions

$43.00Medicare-allowed amount per service, averaged across 66,809 services

Providers submitted

$103.32

Asking price, not received

Medicare allowed

$43.00

The fee schedule figure

Medicare paid

$32.39

Balance is patient coinsurance

Providers submitted an average of $103.32 for this code and Medicare allowed $43.00 — 2.4× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $32.39 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $43.22
Hospital / facility: $38.91

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 63,395 services were billed in an office setting and 3,414 in a facility.

Services: 66,809
Beneficiaries: 18,891
Providers billing it: 532
Total allowed: $2,872,787

What Medicare pays for CPT 98926

Across 66,809 services billed by 532 providers to 18,891 beneficiaries, Medicare allowed an average of $43.00 per service. That is 3.5 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 98926

Specialty	Services	Beneficiaries	Avg allowed	Providers
Family Practice	17,078	6,798	$44.41	261
Nurse Practitioner	14,633	2,422	$37.10	42
Osteopathic Manipulative Medicine	14,547	4,413	$44.96	108
Physical Medicine and Rehabilitation	8,017	2,176	$46.32	47
Sports Medicine	4,734	851	$45.11	18
General Practice	2,389	468	$44.76	9
Internal Medicine	2,130	965	$43.62	22
Physician Assistant	1,747	244	$38.49	4
Rheumatology	265	85	$47.33	1
Emergency Medicine	212	65	$35.56	2
Pain Management	185	75	$45.36	4
Physical Therapist in Private Practice	177	51	$44.66	2
Geriatric Medicine	169	50	$45.58	1
Interventional Pain Management	155	61	$42.44	3
Chiropractic	95	20	$36.02	1

98926 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	14,028	$46.43	$33.47	58
Texas	10,803	$37.30	$28.35	38
New York	5,737	$48.61	$33.36	46
Virginia	3,475	$44.12	$33.26	21
New Jersey	2,758	$43.95	$32.95	12
Michigan	2,245	$40.93	$31.46	41
Alaska	2,138	$49.03	$27.79	12
Pennsylvania	2,027	$44.36	$33.07	20
Ohio	1,746	$38.95	$29.47	26
Oklahoma	1,728	$37.73	$29.56	14
Nevada	1,674	$40.51	$29.54	5
Arizona	1,610	$40.52	$31.51	18
Colorado	1,503	$42.03	$31.67	12
Connecticut	1,348	$46.74	$33.55	8
Missouri	1,263	$41.05	$31.74	17
Oregon	1,162	$41.49	$30.11	14
District of Columbia	1,034	$49.40	$34.07	1
Florida	1,029	$41.77	$31.63	20
New Mexico	971	$40.50	$33.12	6
Illinois	939	$44.46	$33.03	12
Delaware	721	$43.49	$33.82	3
Indiana	671	$41.47	$32.10	11
Hawaii	664	$41.96	$29.58	4
North Carolina	623	$37.92	$29.68	7
Washington	574	$46.63	$32.57	14
Massachusetts	547	$45.76	$33.22	9
Minnesota	515	$39.59	$30.02	10
Wisconsin	461	$38.63	$28.11	9
Maine	438	$35.52	$26.32	12
Iowa	387	$35.54	$28.37	9
New Hampshire	307	$44.90	$33.29	5
Nebraska	276	$41.63	$31.65	3
Maryland	204	$42.27	$29.29	2
Arkansas	185	$35.62	$28.81	3
Kentucky	159	$40.21	$30.69	6
Idaho	135	$36.51	$34.57	2
Tennessee	104	$39.59	$31.54	2
Kansas	104	$41.83	$32.29	3
Utah	102	$42.77	$32.62	2
South Carolina	95	$36.02	$29.35	1
Rhode Island	58	$45.27	$31.10	1
Vermont	47	$43.38	$31.95	2
Montana	39	$42.71	$33.37	2
West Virginia	37	$32.89	$26.87	2
Guam	30	$46.22	$30.23	1
Georgia	29	$35.73	$27.37	2
South Dakota	27	$32.86	$24.90	1
North Dakota	23	$43.67	$29.09	1
Louisiana	15	$33.28	$26.82	1
Wyoming	14	$43.93	$30.04	1

Related codes

98941Chiropractic manipulative treatment$38.12
98940Chiropractic manipulative treatment$26.75
98942Chiropractic manipulative treatment$49.84
98977Device supply$48.07
98976Device supply$48.79
98980Remote therapeutic monitoring treatment management services by physici$49.72
98929Osteopathic manipulative treatment$83.31
98928Osteopathic manipulative treatment$70.48
98927Osteopathic manipulative treatment$57.47
98981Remote therapeutic monitoring treatment management services by physici$38.72
98975Set-up and patient education for remote monitoring of therapy$20.19
98925Osteopathic manipulative treatment$30.48

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.