Understanding occupational therapy billing codes is essential for ensuring that therapists receive proper reimbursement for the valuable care they provide. These codes not only standardize billing procedures but also help ensure compliance with insurance and Medicare guidelines. From assessments to therapy techniques, accurate billing plays a crucial role in both financial and clinical success.
What Are Occupational Therapy Billing Codes?
Occupational therapy billing codes are designed to categorize and document the wide range of services occupational therapists offer. These include:
- Initial evaluations
- Therapeutic activities and exercises
- Self-care training
- Manual techniques and treatments
Using the correct codes ensures that providers are properly reimbursed and remain compliant with payer requirements. The CPT (Current Procedural Terminology) codes are the most widely used system for occupational therapy billing, helping define the type and duration of services provided.
The Importance of Proper OT Billing
Proper billing in occupational therapy is more than just getting paid—it’s about maintaining a smooth, compliant, and effective workflow. Correctly assigning billing codes helps:
Standardize the billing process
Accurately reflect the services rendered
Reduce claim denials and audit risks
Maximize timely reimbursements
Whether you’re billing for an evaluation or a guided therapy session, each code plays a key role in revenue cycle management.
Common Occupational Therapy CPT Codes
Some of the most frequently used OT CPT codes include:
- 97165–97167: Occupational therapy evaluations (low, moderate, and high complexity)
- 97530: Therapeutic activities
- 97110: Therapeutic exercises
- 97535: Self-care and home management training
- 97533: Sensory integration techniques
- 97112: Neuromuscular re-education
Each code corresponds to specific procedures and time spent with the patient, which directly impacts reimbursement.
Billing Units and the 8-Minute Rule
Billing units measure the time spent providing therapy services. For timed codes, therapists follow Medicare’s 8-minute rule:
- 1 unit = 8 to 22 minutes
- 2 units = 23 to 37 minutes
- And so on…
Accurately tracking these units is critical for full reimbursement. Therapists must document the exact time spent on each therapeutic activity to justify the number of units billed.
Medicare and Occupational Therapy Billing
Medicare plays a significant role in OT billing, especially for therapists serving older adults or individuals with disabilities. To ensure compliance:
- Therapists must use appropriate CPT codes
- Understand Medicare’s coverage limits
- Follow documentation and billing guidelines
- Stay updated on reimbursement rates and billing changes
Billing under Medicare requires extra attention to detail, but when done correctly, it ensures that therapists receive fair compensation for covered services.
Key Components of Occupational Therapy Billing
Effective OT billing involves more than just coding—it’s a combination of documentation, compliance, and workflow management. Key components include:
- Initial assessments and evaluations
- Therapeutic exercises and activities
- Manual therapy and treatment techniques
- Patient education and self-care instruction
- Progress documentation
By addressing all these components, therapists can ensure comprehensive care while maintaining a healthy revenue cycle.
How MedRev Supports Occupational Therapy Billing
At MedRev, we understand the complexities of occupational therapy billing and the importance of accuracy in every claim. Our solutions are designed to:
Streamline coding and documentation
Minimize claim denials
Ensure compliance with Medicare and private insurers
Improve revenue cycle performance
Whether you’re an individual therapist or part of a larger practice, MedRev provides the expertise and support to make your billing process easier and more efficient.
Conclusion
Accurate and efficient occupational therapy billing is vital for both financial health and quality care. With standardized CPT codes, a strong understanding of billing units, and a reliable partner like MedRev, therapists can focus on what matters most—helping patients regain independence and improve their quality of life.Need help navigating OT billing complexities? Partner with MedRev for expert billing support that ensures you get reimbursed—accurately and on time.