I assume you are billing in the 98925-98929 range for osteopathic manipulation. It does state in the guidelines prior to those codes that a separate E/M is allowed with a modifier 25 and it may be prompted by the same symptoms as for the manipulation.
Have you called the insurance and asked someone (in person) why they continue to deny when the separate E/M is clearly allowed and is paid when billed under other providers? If not, then I would suggest that be the next step with that insurance. You want them to give you a policy in writing that states their coverage position. It may even need to go to the level of a provider- to- medical director appeal. Pull out the guidelines as written in the CPT book and have a copy of those available when appealing, it can also help to show that other insurance carriers to pay in this situation.
Be sure the documentation in the chart very clearly shows the extra work that justifies the addition of the E/M code.
Good luck and don't give up!
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