Occupational Therapy Billing Services

Occupational therapy covers a wide range of care, from hand injuries to pediatric development to helping older adults stay independent. That variety makes occupational therapy billing harder than it looks. Many services are timed, many payers set their own visit limits, and the same code can be paid very differently depending on the setting.

Clinics also see a mix of insurance, school-based funding, Medicaid, and workers' compensation. Each has its own forms and rules. Westmont connects occupational therapy practices and facilities with vetted billing experts who understand this mix. They can help you submit complete claims, track plans of care, and follow up on denials so therapists can spend their time on patients.

Who this is for

• Outpatient OT clinics and hand therapy practices
• Pediatric therapy clinics serving developmental and sensory needs
• Occupational therapists in private practice
• Multi-discipline rehab groups that include OT
• Skilled nursing and outpatient hospital therapy departments
• Practices that treat workers' compensation injuries

What gets billed

• OT evaluations at low, moderate, and high complexity
• OT re-evaluations
• Therapeutic activities
• Self-care and home management training
• Community and work reintegration training
• Therapeutic exercise
• Neuromuscular re-education
• Manual therapy
• Wheelchair management and training
• Orthotic management and training
• Group therapy
• Sensory integration and developmental treatment, where payers allow it

Commonly billed codes

Code	Type	What it covers
97165	CPT	OT evaluation, low complexity
97166	CPT	OT evaluation, moderate complexity
97167	CPT	OT evaluation, high complexity
97168	CPT	OT re-evaluation
97530	CPT	Therapeutic activities, each 15 minutes
97535	CPT	Self-care and home management training, each 15 minutes
97537	CPT	Community or work reintegration training, each 15 minutes
97110	CPT	Therapeutic exercise, each 15 minutes
97150	CPT	Therapeutic procedure in a group setting
97542	CPT	Wheelchair management and training, each 15 minutes
GO	Modifier	Marks services delivered under an occupational therapy plan of care
F82	ICD-10-CM	Developmental coordination disorder
G56.00	ICD-10-CM	Carpal tunnel syndrome, unspecified upper limb

Note

Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Billing challenges in occupational therapy

Choosing between similar codes. Therapeutic activities, self-care training, and therapeutic exercise can overlap in practice. Billers experienced in OT read the note and match each service to the code the documentation supports.

Timed units. Most OT treatment codes are counted in 15-minute increments. A billing expert checks total minutes against units, using the counting rule each payer follows.

Evaluation complexity. Payers expect the evaluation level to match documented history, performance deficits, and decision-making. Billers flag mismatches before submission.

Visit caps and authorizations. Many plans limit combined therapy visits across PT, OT, and speech. Tracking shared limits prevents surprise denials, especially for children with multiple therapies.

Medicaid and school-based billing. Rules differ by state, including who can bill, which codes are covered, and what consent forms are required. Experienced billers keep state manuals close.

Assistant services. Services performed by occupational therapy assistants usually need a specific modifier and may be paid at a lower rate by Medicare and some payers. Consistent modifier use avoids rework.

Hand therapy and splinting. Splint supplies and fabrication may be billed with separate codes that require clear notes. Billers confirm whether the payer covers them.

How Westmont can help

• Matching your practice with vetted billing experts experienced in occupational therapy billing
• End-to-end revenue cycle support, from verification to payment posting
• Denial management, including appeals tied to plan of care and visit limits
• Help with credentialing and payer enrollment for new therapists
• Clear reporting on units, visits, and outstanding claims

Frequently asked questions

What modifier do occupational therapists use?

Medicare requires the GO modifier on therapy services delivered under an occupational therapy plan of care. Some other payers use it too. Physical therapy uses GP and speech uses GN. Also check for assistant modifiers when an occupational therapy assistant provides care, since payers may treat those claims differently.

How are OT evaluation codes chosen?

The level depends on documented factors such as the patient's history, how many performance areas are affected, clinical decision-making, and the complexity of the case. The note should support the level billed. Billers often review evaluation notes for clarity so payers do not downcode them.

Can occupational therapists bill Medicare directly?

Yes. Occupational therapists in private practice can enroll in Medicare and bill for covered services, and facilities bill under their own rules. Enrollment requirements change, so confirm current details with your Medicare contractor before you start seeing Medicare patients.

Why do pediatric OT claims get denied?

Common causes include visit limits shared with other therapies, plans that exclude developmental care, missing diagnoses that meet policy, and authorizations that expired. A specialty biller checks benefits first so families and clinics know coverage before treatment begins.

Do you work with school-based or Medicaid OT billing?

Rules vary by state, so we match you with billing experts who know your state's Medicaid program and documentation needs. Tell us your state and funding sources when you contact Westmont, and we will look for the right fit.

Related billing services

• Physical Therapy
• Speech-Language Pathology
• ABA & Autism Services
• Pediatrics
• Physical Medicine & Rehabilitation
• Skilled Nursing Facilities