CPT code 98926: Osteopathic manipulation, three to four regions2026 Medicare rate & RVUs in Puerto Rico
Report this service when a physician performs osteopathic manipulative treatment on three or four distinct body regions for documented somatic dysfunction.
In Puerto Rico, Medicare pays $46.31 for 98926 in the office and $29.77 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 98926 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 98926 covers
A physician, commonly an osteopathic physician, uses manual techniques to treat somatic dysfunction in three or four body regions during an office visit or other clinical encounter. The regions may include the head, neck, thoracic or lumbar areas, sacrum, pelvis, ribs, abdomen, or upper or lower extremities. The code reflects the number of distinct regions treated, not the number of techniques used or the number of findings documented.
Document the regions treated and the clinical findings supporting treatment there. Report one service for treatment of three or four regions. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. Modifier 50 is inappropriate for bilateral treatment. CMS pays an assistant at surgery only when medical necessity is documented; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
How Puerto Rico compares for 98926
Across 109 of 109 payment localities, the office rate for 98926 runs from $42.38 in Arkansas to $58.43 in Alaska. Puerto Rico pays $46.31. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$46.31
- Los Angeles, CA · California$50.56+$4.25
- Washington, DC area · District of Columbia$51.35+$5.04
- Miami, FL · Florida$49.03+$2.72
- Chicago, IL · Illinois$48.09+$1.78
- Manhattan, NY · New York$51.87+$5.56
- Alaska · Alaska$58.43+$12.12
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $42.80 | $28.48 |
| ArkansasArkansas | $42.38 | $28.33 |
| ArizonaArizona | $45.23 | $29.37 |
| Bakersfield, CACalifornia | $48.09 | $30.16 |
| Chico, CACalifornia | $47.95 | $30.01 |
| El Centro, CACalifornia | $47.96 | $30.02 |
| Fresno, CACalifornia | $47.95 | $30.01 |
| Hanford, CACalifornia | $47.95 | $30.01 |
| Madera, CACalifornia | $47.95 | $30.01 |
| Merced, CACalifornia | $47.95 | $30.01 |
| Modesto, CACalifornia | $47.95 | $30.01 |
| Napa, CACalifornia | $53.79 | $32.22 |
| Oxnard, CACalifornia | $50.19 | $30.84 |
| Redding, CACalifornia | $47.95 | $30.01 |
| Rest of CaliforniaCalifornia | $47.95 | $30.01 |
| Riverside, CACalifornia | $48.40 | $30.46 |
| Sacramento, CACalifornia | $49.84 | $30.81 |
| Salinas, CACalifornia | $49.64 | $30.67 |
| San Diego, CACalifornia | $50.43 | $30.85 |
| Marin County, CACalifornia | $56.46 | $33.38 |
| San Francisco, CACalifornia | $56.42 | $33.34 |
| San Benito County, CACalifornia | $57.60 | $34.00 |
| Santa Clara County, CACalifornia | $57.42 | $33.82 |
| San Luis Obispo, CACalifornia | $48.88 | $30.24 |
| Santa Cruz, CACalifornia | $50.63 | $30.74 |
| Santa Maria, CACalifornia | $49.72 | $30.64 |
| Santa Rosa, CACalifornia | $51.11 | $31.02 |
| Stockton, CACalifornia | $47.95 | $30.01 |
| Vallejo, CACalifornia | $53.73 | $32.16 |
| Visalia, CACalifornia | $47.95 | $30.01 |
| Yuba City, CACalifornia | $47.95 | $30.01 |
| ColoradoColorado | $47.47 | $30.05 |
| ConnecticutConnecticut | $48.51 | $30.88 |
| DelawareDelaware | $45.81 | $29.64 |
| Fort Lauderdale, FLFlorida | $47.45 | $30.88 |
| Rest of FloridaFlorida | $45.81 | $30.16 |
| Atlanta, GAGeorgia | $46.78 | $30.15 |
| Rest of GeorgiaGeorgia | $44.01 | $29.41 |
| Hawaii, Guam, HIHawaii | $48.51 | $29.90 |
| IowaIowa | $43.44 | $28.47 |
| IdahoIdaho | $43.65 | $28.60 |
| East St. Louis, ILIllinois | $45.71 | $30.65 |
| Rest of IllinoisIllinois | $44.96 | $30.01 |
| Suburban Chicago, ILIllinois | $47.87 | $31.06 |
| IndianaIndiana | $43.82 | $28.65 |
| KansasKansas | $43.35 | $28.55 |
| KentuckyKentucky | $43.57 | $29.02 |
| New Orleans, LALouisiana | $44.99 | $29.59 |
| Rest of LouisianaLouisiana | $43.54 | $29.06 |
| Metropolitan Boston, MAMassachusetts | $51.10 | $31.56 |
| Rest of MassachusettsMassachusetts | $47.34 | $30.11 |
| Baltimore area, MDMaryland | $48.36 | $30.80 |
| Rest of MarylandMaryland | $46.47 | $29.91 |
| Rest of MaineMaine | $43.85 | $28.79 |
| Southern Maine, MEMaine | $45.40 | $29.19 |
| Detroit, MIMichigan | $46.25 | $30.46 |
| Rest of MichiganMichigan | $44.38 | $29.43 |
| MinnesotaMinnesota | $45.78 | $28.94 |
| Metropolitan Kansas City, MOMissouri | $44.74 | $29.37 |
| Metropolitan St. Louis, MOMissouri | $45.05 | $29.47 |
| Rest of MissouriMissouri | $43.06 | $28.95 |
| MississippiMississippi | $42.73 | $28.64 |
| MontanaMontana | $46.09 | $29.72 |
| North CarolinaNorth Carolina | $44.16 | $28.89 |
| North DakotaNorth Dakota | $45.30 | $28.93 |
| NebraskaNebraska | $43.59 | $28.48 |
| New HampshireNew Hampshire | $46.82 | $29.78 |
| Northern New JerseyNew Jersey | $51.11 | $32.12 |
| Rest of New JerseyNew Jersey | $49.14 | $31.27 |
| New MexicoNew Mexico | $44.56 | $29.55 |
| NevadaNevada | $45.89 | $29.51 |
| NYC suburbs and Long Island, NYNew York | $52.82 | $33.36 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $49.47 | $31.55 |
| Queens, NYNew York | $52.11 | $32.76 |
| Rest of New YorkNew York | $44.61 | $29.06 |
| OhioOhio | $44.22 | $29.27 |
| OklahomaOklahoma | $43.47 | $28.86 |
| Portland, OROregon | $48.53 | $30.35 |
| Rest of OregonOregon | $45.61 | $29.31 |
| Metropolitan Philadelphia, PAPennsylvania | $47.66 | $30.62 |
| Rest of PennsylvaniaPennsylvania | $44.24 | $29.22 |
| Rhode IslandRhode Island | $47.10 | $30.20 |
| South CarolinaSouth Carolina | $44.24 | $29.12 |
| South DakotaSouth Dakota | $45.21 | $28.84 |
| TennesseeTennessee | $43.50 | $28.62 |
| Austin, TXTexas | $47.25 | $29.93 |
| Beaumont, TXTexas | $44.04 | $29.15 |
| Brazoria, TXTexas | $45.79 | $29.57 |
| Dallas, TXTexas | $46.02 | $29.72 |
| Fort Worth, TXTexas | $45.82 | $29.69 |
| Galveston, TXTexas | $45.90 | $29.64 |
| Houston, TXTexas | $46.63 | $30.38 |
| Rest of TexasTexas | $44.86 | $29.32 |
| UtahUtah | $44.65 | $29.27 |
| VirginiaVirginia | $45.33 | $29.24 |
| Virgin Islands, VIUnited States Virgin Islands | $46.31 | $29.77 |
| VermontVermont | $45.22 | $29.01 |
| Rest of WashingtonWashington | $47.22 | $29.99 |
| King County, WAWashington | $51.93 | $31.85 |
| WisconsinWisconsin | $44.26 | $28.58 |
| West VirginiaWest Virginia | $43.82 | $29.60 |
| WyomingWyoming | $45.75 | $29.38 |
98926 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$42.38
$58.43
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $58.43 | 1 |
| AL | $42.80 | 1 |
| AR | $42.38 | 1 |
| AZ | $45.23 | 1 |
| CA | $47.95–$57.60 | 29 |
| CO | $47.47 | 1 |
| CT | $48.51 | 1 |
| DC | $51.35 | 1 |
| DE | $45.81 | 1 |
| FL | $45.81–$49.03 | 3 |
| GA | $44.01–$46.78 | 2 |
| GU | $48.51 | 1 |
| HI | $48.51 | 1 |
| IA | $43.44 | 1 |
| ID | $43.65 | 1 |
| IL | $44.96–$48.09 | 4 |
| IN | $43.82 | 1 |
| KS | $43.35 | 1 |
| KY | $43.57 | 1 |
| LA | $43.54–$44.99 | 2 |
| MA | $47.34–$51.10 | 2 |
| MD | $46.47–$51.35 | 3 |
| ME | $43.85–$45.40 | 2 |
| MI | $44.38–$46.25 | 2 |
| MN | $45.78 | 1 |
| MO | $43.06–$45.05 | 3 |
| MS | $42.73 | 1 |
| MT | $46.09 | 1 |
| NC | $44.16 | 1 |
| ND | $45.30 | 1 |
| NE | $43.59 | 1 |
| NH | $46.82 | 1 |
| NJ | $49.14–$51.11 | 2 |
| NM | $44.56 | 1 |
| NV | $45.89 | 1 |
| NY | $44.61–$52.82 | 5 |
| OH | $44.22 | 1 |
| OK | $43.47 | 1 |
| OR | $45.61–$48.53 | 2 |
| PA | $44.24–$47.66 | 2 |
| PR | $46.31 | 1 |
| RI | $47.10 | 1 |
| SC | $44.24 | 1 |
| SD | $45.21 | 1 |
| TN | $43.50 | 1 |
| TX | $44.04–$47.25 | 8 |
| UT | $44.65 | 1 |
| VA | $45.33–$51.35 | 2 |
| VI | $46.31 | 1 |
| VT | $45.22 | 1 |
| WA | $47.22–$51.93 | 2 |
| WI | $44.26 | 1 |
| WV | $43.82 | 1 |
| WY | $45.75 | 1 |
How the 98926 rate is calculated
Each of 98926’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 98926
RVUs × geographic indexes × conversion factor
Work0.69
0.69 RVUs× 1.000 GPCI
Practice expense0.65
0.65 RVUs× 1.000 GPCI
Malpractice0.04
0.04 RVUs× 1.000 GPCI
Adjusted RVUs
1.3800
Conversion factor
$33.4009
Medicare rate
$46.09
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
12,938
- Code
- 98926
- Physician work
- 0.69
- Practice expense
- 0.65
- Malpractice
- 0.04
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.69 | × 1.000 | 0.6900 |
| Practice expense | 0.65 | × 1.011 | 0.6572 |
| Malpractice | 0.04 | × 0.985 | 0.0394 |
| Total RVUs | 1.3866 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Puerto Rico$46.31
Office: (0.69 × 1 + 0.65 × 1.011 + 0.04 × 0.985) × $33.4009 = $46.31
Facility: (0.69 × 1 + 0.16 × 1.011 + 0.04 × 0.985) × $33.4009 = $29.77
Payment rules and modifiers for 98926
The CMS indicators that decide how 98926 is paid alongside other services.
CMS payment indicators · 98926
Osteopathic manipulation, three to four regions
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
How 98926 has changed in Puerto Rico
98926 · Office / nonfacility
$46.31
Effective 2026-10-01
The base rate is $2.20 higher than on 2025-10-01, moving from $44.11 to $46.31 (5.0%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$44.11changed to$46.31
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.71 changed to 0.69
- Practice expense RVU 0.61 changed to 0.65
- Practice expense GPCI 1.007 changed to 1.011
- Malpractice GPCI 0.982 changed to 0.985
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$45.05changed to$44.11
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 0.60 changed to 0.61
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$44.32changed to$45.05
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$45.21changed to$44.32
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 0.58 changed to 0.60
- Practice expense GPCI 1.008 changed to 1.007
- Malpractice GPCI 0.984 changed to 0.982
October 1, 2023
RVU23D
$45.07changed to$45.21
- Practice expense GPCI 1.000 changed to 1.008
- Malpractice GPCI 1.000 changed to 0.984
January 1, 2023
RVU23A
$45.47changed to$45.07
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 0.56 changed to 0.58
- Practice expense GPCI 1.008 changed to 1.000
- Malpractice GPCI 0.986 changed to 1.000
Held through RVU23B, RVU23C.
January 1, 2022
RVU22A
$45.50changed to$45.47
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 0.55 changed to 0.56
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$46.69changed to$45.50
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 0.53 changed to 0.55
- Malpractice RVU 0.05 changed to 0.04
- Malpractice GPCI 0.988 changed to 0.986
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$46.25changed to$46.69
- Conversion factor 36.0391 changed to 36.0896
- Malpractice RVU 0.04 changed to 0.05
- Practice expense GPCI 1.007 changed to 1.008
- Malpractice GPCI 0.990 changed to 0.988
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$46.92changed to$46.25
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 0.55 changed to 0.53
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$42.99changed to$46.92
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 0.54 changed to 0.55
- Practice expense GPCI 0.856 changed to 1.007
- Malpractice GPCI 0.642 changed to 0.990
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$39.47changed to$42.99
- Conversion factor 35.8043 changed to 35.8887
- Practice expense GPCI 0.705 changed to 0.856
- Malpractice GPCI 0.293 changed to 0.642
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$39.51changed to$39.47
- Conversion factor 35.9335 changed to 35.8043
- Malpractice RVU 0.03 changed to 0.04
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$39.31changed to$39.51
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$38.86changed to$39.31
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 0.53 changed to 0.54
- Practice expense GPCI 0.692 changed to 0.705
- Malpractice GPCI 0.271 changed to 0.293
Held through RVU15B.
January 1, 2014
RVU14A
$37.56changed to$38.86
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 0.57 changed to 0.53
- Practice expense GPCI 0.678 changed to 0.692
- Malpractice GPCI 0.249 changed to 0.271
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $37.56
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $46.31 | $29.77 | RVU26D |
| 2026-07-01 | $46.31 | $29.77 | RVU26C |
| 2026-04-01 | $46.31 | $29.77 | RVU26B |
| 2026-01-01 | $46.31 | $29.77 | RVU26A |
| 2025-10-01 | $44.11 | $33.36 | RVU25D |
| 2025-07-01 | $44.11 | $33.36 | RVU25C |
| 2025-04-01 | $44.11 | $33.36 | RVU25B |
| 2025-01-01 | $44.11 | $33.36 | RVU25A |
| 2024-10-01 | $45.05 | $34.33 | RVU24D |
| 2024-07-01 | $45.05 | $34.33 | RVU24C |
| 2024-04-01 | $45.05 | $34.33 | RVU24B |
| 2024-03-09 | $45.05 | $34.33 | RVU24AR |
| 2024-01-01 | $44.32 | $33.77 | RVU24A |
| 2023-10-01 | $45.21 | $34.96 | RVU23D |
| 2023-07-01 | $45.07 | $34.90 | RVU23C |
| 2023-04-01 | $45.07 | $34.90 | RVU23B |
| 2023-01-01 | $45.07 | $34.90 | RVU23A |
| 2022-10-01 | $45.47 | $35.70 | RVU22D |
| 2022-07-01 | $45.47 | $35.70 | RVU22C |
| 2022-04-01 | $45.47 | $35.70 | RVU22B |
| 2022-01-01 | $45.47 | $35.70 | RVU22A |
| 2021-10-01 | $45.50 | $36.00 | RVU21D |
| 2021-07-01 | $45.50 | $36.00 | RVU21C |
| 2021-04-01 | $45.50 | $36.00 | RVU21B |
| 2021-01-01 | $45.50 | $36.00 | RVU21A |
| 2020-10-01 | $46.69 | $37.23 | RVU20D |
| 2020-07-01 | $46.69 | $37.23 | RVU20C |
| 2020-04-01 | $46.69 | $37.23 | RVU20B |
| 2020-01-01 | $46.69 | $37.23 | RVU20A |
| 2019-10-01 | $46.25 | $36.81 | RVU19D |
| 2019-07-01 | $46.25 | $36.81 | RVU19C |
| 2019-04-01 | $46.25 | $36.81 | RVU19B |
| 2019-01-01 | $46.25 | $36.81 | RVU19A |
| 2018-10-01 | $46.92 | $36.77 | RVU18D |
| 2018-07-01 | $46.92 | $36.77 | RVU18C |
| 2018-04-01 | $46.92 | $36.77 | RVU18B |
| 2018-01-01 | $46.92 | $36.77 | RVU18AR1 |
| 2017-10-01 | $42.99 | $34.70 | RVU17D |
| 2017-07-01 | $42.99 | $34.70 | RVU17C |
| 2017-04-01 | $42.99 | $34.70 | RVU17B |
| 2017-01-01 | $42.99 | $34.70 | RVU17A |
| 2016-10-01 | $39.47 | $32.66 | RVU16D |
| 2016-07-01 | $39.47 | $32.66 | RVU16C |
| 2016-04-01 | $39.47 | $32.66 | RVU16B |
| 2016-01-01 | $39.47 | $32.66 | RVU16A |
| 2015-10-01 | $39.51 | $32.67 | RVU15D |
| 2015-07-01 | $39.51 | $32.67 | RVU15C |
| 2015-04-01 | $39.31 | $32.51 | RVU15B |
| 2015-01-01 | $39.31 | $32.51 | RVU15A |
| 2014-10-01 | $38.86 | $32.42 | RVU14D |
| 2014-07-01 | $38.86 | $32.42 | RVU14C |
| 2014-04-01 | $38.86 | $32.42 | RVU14B |
| 2014-01-01 | $38.86 | $32.42 | RVU14A |
| 2013-10-01 | $37.56 | $30.87 | RVU13D |
| 2013-07-01 | $37.56 | $30.87 | RVU13C |
| 2013-04-01 | $37.56 | $30.87 | RVU13B |
| 2013-01-01 | $37.56 | $30.87 | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
98926 billing questions
How do I choose between 98925, 98926, and 98927?
Count the distinct body regions treated: 98925 covers one or two, 98926 covers three or four, and 98927 covers five or six.
Do I count each technique or each side as a separate region?
No. Count distinct treated body regions, not the number of manual techniques or sides treated within a region.
Can an E/M service be reported on the same date?
A significant, separately identifiable E/M service may be reported with modifier 25. The documentation should distinguish that evaluation and management work from the OMT service.
Should modifier 50 be appended when both sides are treated?
No. CMS identifies bilateral adjustment as inappropriate for this code; treatment on both sides does not make it a bilateral service.
What documentation supports reporting 98926?
Record the somatic dysfunction findings and identify the three or four distinct regions actually treated.
What is included in the global period?
The 0-day global period includes same-day preoperative and postoperative care.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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