Occupational Therapy CPT Codes
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CPT® codes are commonly used among occupational therapists. Whether you work in a hospital, outpatient, or private practice setting, it’s important to have a foundational understanding of CPT codes. That way, you can accurately bill for the services you provide as an OT.
What are CPT codes in occupational therapy?
CPT code stands for Current Procedural Terminology code and was developed by the American Medical Association. These codes describe the services and procedures you provide as an occupational therapist and are included on insurance claims you submit to your insurance payer.
One thing to note: if your practice is private pay only, you still need to use CPT codes on a superbill if your client intends to seek reimbursement from their medical insurance carriers.
Common occupational therapy evaluation CPT codes
In 2017, occupational therapy Evaluation CPT codes changed from one overall OT Evaluation code to three different options—depending on the intensity of the OT evaluation. This change was made in an effort to accurately reflect the services OTs provide in their evaluation based on the complexity and needs of the client.
For occupational therapy evaluations, there are three Evaluation codes based on the complexity of the evaluation.
| Evaluation Code | Low complexity (97165) | Moderate Complexity (97166) | High complexity (97167) |
|---|---|---|---|
| Occupational Profile and Medical/Therapy History | Problem-focused | Detailed | Comprehensive |
| Patient Assessment | Problem-focused | Detailed | Comprehensive |
| Clinical Decision Making | Low | Moderate | High |
What is a re-evaluation CPT code for occupational therapists?
An occupational therapy Re-evaluation CPT code is typically used every 12 months, or when a client has made significant progress and it’s time to reassess if the client has a continued need for occupational therapy. There is one code for re-evaluation that OTs use.
- CPT code 97168 - Occupational Therapy Re-evaluation
10 common occupational therapy therapeutic procedure treatment CPT codes
While there are hundreds of CPT treatment codes available, there are 10 common codes occupational therapists use.
If you’re not sure which CPT to use, it’s best practice to directly reach out to your insurance payer, or your state occupational therapy board and association for guidance. The American Occupational Therapy Association (AOTA) also provides resources for OTs when it comes to billing.
- CPT code 97110 - Therapeutic exercise to develop strength and endurance, range of motion and flexibility (one or more areas, each 15 minutes)
- CPT code 97112 - Neuromuscular Re-education of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities (one or more areas, each 15 minutes)
- CPT code 97113 - Aquatic Therapy with Therapeutic Exercises (one or more areas, each 15 minutes)
- CPT code 97140 - Manual Therapy Techniques (e.g.,mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes
- CPT code 97150 - Therapeutic Procedure(s), Group (2 or more individuals)
- CPT code 97530 - Therapeutic Activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes
- CPT code 97533 - Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes
- CPT code 97535 - Self–care/home management training (e.g., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 minutes
- CPT code 97537 - Community/Work Reintegration Training (e.g., shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis) direct one-on-one contact, each 15 minutes
- CPT code 97542 - Wheelchair Management (e.g., assessment, fitting, training), each 15 minutes
Understanding Medicare’s “8-minute rule”
Medicare’s 8-minute rule is used to help occupational therapists calculate how many units of a CPT code they should bill. It specifically states, “Providers should not bill for services performed for less than 8 minutes. For any single-timed CPT code in the same day measured in 15-minute units, providers bill a single 15-minute unit for treatment greater than or equal to 8 minutes through and including 22 minutes.”
Centers for Medicare & Medicaid Services (CMS) provided this table (also shown below) that can be a helpful visual of how the 8-minute rule works.
Units Number of minutes 1 unit ≤ 8 minutes through 22 minutes 2 units ≤ 23 minutes through 37 minutes 3 units ≤ 38 minutes through 52 minutes 4 units ≤ 53 minutes through 67 minutes 5 units ≤ 68 minutes through 82 minutes 6 units ≤ 83 minutes through 97 minutes 7 units ≤ 98 minutes through 112 minutes 8 units ≤ 113 minutes through 127 minutes
To sum up, Medicare’s 8-minute rule states that an occupational therapist must provide direct service for at least 8 minutes to receive reimbursement for a time-based CPT treatment code.
3 CPT code billing tips for OTs
Here are some general tips to keep in mind when it comes to CPT codes for OTs.
- If you’re an in-network provider and are seeing clients who have insurance, do research ahead of time as to what codes are and are not reimbursed by a client’s insurance company.
- Changes to CPT codes and reimbursement typically happens on an annual basis. Make sure to keep up to date with these changes through the CMS website.
- Document which CPT codes you use at the time of service rather than the next day. It can get difficult to remember which codes to bill for each one when you have a growing caseload. In addition, the sooner you can submit a claim to the insurance company, the sooner you get paid.
Where can I find more information about CPT codes?
There are many places where you can find information about CPT codes. The CMS (Centers for Medicare & Medicaid Services) is a great resource when billing outpatient settings about CPT codes used to bill in outpatient settings. You can also check out AOTA but keep in mind, you’ll need to be an AOTA member to access all their resources.
How to use CPT codes with your EMR
Many top-rated EMR softwares like SimplePractice have free resources you can download to help expand your knowledge on billing and coding. As a reminder, the American Medical Association makes updates to CPT codes every year, so be on the lookout for those changes.
If you’re interested in finding out how you can streamline your practice and simplify insurance billing, start a free, 30-day trial with SimplePractice today. It’s the only HIPAA-compliant EMR that allows you to seamlessly select and bill OT codes. It also offers simple scheduling, HIPAA-compliant secure messaging, and more that work specifically for occupational therapists.
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