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Occupational Therapy Medical Billing

Occupational Therapy Medical Billing

Occupational therapy (OT) is a healthcare profession focused on helping individuals of all ages participate in meaningful activities, or “occupations,” that are essential for daily living and overall well-being. These activities may include self-care tasks, productive activities such as work or school, and leisure pursuits. Occupational therapists (OTs) work with people who have physical, cognitive, developmental, or emotional challenges that interfere with their ability to engage in these activities independently.


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The aim of occupational therapy is to enable individuals to participate in activities that are meaningful and important to them, despite any limitations or disabilities they may have. OT interventions are designed to promote independence, improve functional abilities, enhance quality of life, and facilitate successful engagement in everyday activities.


The aim of occupational therapy is to empower individuals to live fulfilling, independent, and productive lives, despite any challenges they may face. By focusing on the meaningful activities that are central to a person’s identity and well-being, occupational therapists help individuals achieve their highest level of functioning and participation in society.

Occupational Therapy Billing and Documentation

Accurate billing documentation is crucial for ensuring timely reimbursement and compliance with regulatory requirements. Occupational therapy billing documentation `includes comprehensive assessment findings, treatment plans, progress notes, and discharge summaries. Documentation should be clear, concise, and specific to each patient’s needs, outlining the goals of therapy and the interventions provided.

New Occupational Therapy Evaluation Codes

These codes are implemented to improve accuracy and consistency in billing, require detailed documentation of patient history, examination, clinical decision-making, and complexity of service provided. Our team stays abreast of these changes to ensure compliance and optimize reimbursement for our clients.

New CPT Codes for Occupational Therapy

In addition to evaluation codes, new CPT codes for occupational therapy services have been introduced to reflect the evolving nature of the profession. These codes encompass a wide range of interventions, from therapeutic exercises and manual therapy techniques to cognitive retraining and adaptive equipment training. We assist healthcare providers in selecting the appropriate CPT codes and documenting the services rendered to maximize reimbursement.

Evaluation Codes

97165: Occupational therapy evaluation, low complexity, requiring 20 minutes of therapist time.

97166: Occupational therapy evaluation, moderate complexity, requiring 30 minutes of therapist time.

97167: Occupational therapy evaluation, high complexity, requiring 45 minutes of therapist time.

Re-evaluation Code:

97168: Occupational therapy re-evaluation, requiring 20 minutes of therapist time.

Intervention Codes:

97169: Occupational therapy intervention, low complexity, requiring 15 minutes of therapist time.

97170: Occupational therapy intervention, moderate complexity, requiring 30 minutes of therapist time.

97171: Occupational therapy intervention, high complexity, requiring 45 minutes of therapist time.

These intervention codes encompass a wide range of therapeutic activities and techniques conducted by occupational therapists to address functional deficits, improve motor skills, enhance cognitive abilities, and promote independence in activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

Group Therapy Code:

97172: Occupational therapy group therapy, per session, requiring 2 or more individuals.

This code allows occupational therapists to bill for group therapy sessions conducted with two or more patients simultaneously, facilitating peer interaction, socialization, and skill-building in a group setting.

Remote Therapy Services:

97173: Occupational therapy evaluation, remote assessment and monitoring, requiring 20 minutes of therapist time.

97174: Occupational therapy intervention, remote, requiring 15 minutes of therapist time.

These codes cater to the growing demand for telehealth and remote therapy services, enabling occupational therapists to deliver assessments and interventions virtually, leveraging technology to overcome geographical barriers and increase access to care.

These new CPT codes for occupational therapy reflect the profession’s commitment to evidence-based practice, patient-centered care, and interdisciplinary collaboration. Our billing staff utilize these codes to accurately document and bill for occupational therapy services, ensuring optimal reimbursement and compliance with coding guidelines.

Patient-Specific Functional Scale:

The patient-specific functional scale (PSFS) is a valuable tool used in occupational therapy to assess and track individualized functional goals. This scale allows patients to identify meaningful activities that are important to them and rate their ability to perform these activities. By incorporating the PSFS into therapy sessions, occupational therapists can tailor interventions to address specific functional deficits and monitor progress over time.

Functional Reporting Using G-Codes:

Functional reporting using G-codes is a Medicare requirement aimed at documenting a patient’s functional status and progress during therapy. G-codes, along with severity modifiers, provide objective measures of a patient’s functional abilities and limitations. Our integrated billing solutions streamline the process of functional reporting, ensuring accurate documentation and compliance with Medicare guidelines.

Severity Modifiers:

The modifier “Impairment Limitation Restriction” (ILR) is a term used in the context of functional reporting in healthcare, particularly in relation to Medicare’s requirements for reporting functional status using G-codes and severity modifiers. The ILR modifier provides additional specificity regarding the nature and extent of a patient’s functional impairment, limitation, or restriction within a specific functional category.

When reporting functional status using G codes, Our billing staff use severity modifiers (1 to 7) to indicate the severity level of the patient’s impairment or limitation within each functional category.

At DoctorsBackOffice,

we are committed to supporting healthcare providers in delivering high-quality occupational therapy services through comprehensive billing documentation, adherence to coding guidelines, and utilization of functional assessment tools.


Contact us today to learn more about how we can optimize your occupational therapy billing and documentation processes.