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Occupational Therapy Billing Units

Learn about Occupational Therapy Billing Units. Discover standard CPT codes, billing tips, and why Carepatron can streamline your billing process.

By Olivia Sayson on Jun 16, 2024.

Fact Checked by Ericka Pingol.

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Occupational Therapy Billing Units: 2024 Guide

What are Occupational Therapy (OT) Billing Units?

Occupational therapy (OT) billing units reimburse therapy services provided by occupational therapists. These units quantify the value of therapeutic interventions and evaluations conducted during sessions of occupational therapy practice and are divided into two main categories: timed and untimed services.

Timed services are based on the duration of therapy sessions and adhere to the 8-minute rule, where services exceeding 8 minutes are billed in 15-minute increments. Examples of timed services include therapeutic exercises, manual therapy, and neuromodulatory electrical stimulation (NMES).

Untimed services are billed as a single unit regardless of session duration and are typically reserved for evaluations. These evaluations, categorized by complexity, help therapists assess patients' needs and develop tailored treatment plans. Occupational therapy evaluation codes, such as those for low, moderate, and high complexity evaluations, fall under this category.

Types of OT Billing Units

OT billing units are the foundation for getting reimbursed by insurance companies for your services. There are two main types:

  • Timed codes: These codes represent the duration of a treatment session. They follow the 8-minute rule (explained below) and are billed in 15-minute increments.
  • Untimed codes: These codes are billed for a single unit regardless of the time spent. They are typically used for evaluations and re-evaluations that involve a detailed assessment of a patient's medical status, therapy history, and occupational needs.

What are occupational therapy evaluation codes?

Occupational therapy evaluation codes are specific Current Procedural Terminology (CPT) codes used for patient billing when an occupational therapist conducts an initial patient assessment. These codes categorize the evaluation process's complexity based on the detail level and resources required.

Common Occupational therapy CPT codes

Occupational therapy CPT codes categorize services provided to patients. Evaluation codes assess needs (low, moderate, or high complexity). Timed codes for occupational therapy (billed in 15-minute increments) represent treatment sessions like therapeutic exercise or gait training. Untimed codes, like developmental screenings, are billed per unit regardless of time spent.

Here's a breakdown of some common CPT codes used in occupational therapy billing, categorized by service type:

Evaluation codes:

The following are specific CPT codes used in occupational therapy billing for different levels of evaluation services:

  • 97165: Low complexity evaluation: This code is used for a comprehensive evaluation with low complexity, typically involving straightforward patient cases requiring minimal clinical decision-making. It may include reviewing the patient's history, a limited examination, and straightforward clinical decision-making.
  • 97166: Moderate complexity evaluation: This code is used for a comprehensive review with moderate complexity, indicating patient cases that require more in-depth assessment and analysis. It involves a more extensive patient history review, a more detailed examination, and mild clinical decision-making.
  • 97167: High complexity evaluation: This code is used for a comprehensive review with high complexity, indicating patient cases that are particularly complex and challenging. It involves a thorough review of the patient's history, a comprehensive examination, and high-level clinical decision-making, often requiring integrating multiple data sources and considering comorbidities or complicating factors.

Treatment timed codes (billed in 15-minute increments)

These are the CPT codes used in occupational therapy billing for various treatment services, billed in 15-minute increments:

  • 97110: Therapeutic exercise: This code is used for therapeutic exercises aimed at improving strength, endurance, flexibility, and range of motion.
  • 97112: Neuromuscular reeducation: This code uses techniques to improve movement, balance, coordination, kinesthetic sense, posture, and proprioception.
  • 97116: Gait training: This code is used to improve a patient's ability to walk, including exercises, use of assistive devices, and training in walking techniques.
  • 97140: Manual therapy: This code is used for hands-on techniques aimed at mobilizing soft tissues and joints to decrease pain, increase range of motion, and improve function.
  • 97530: Therapeutic activities: This code is used for activities designed to improve functional performance, such as dynamic activities to enhance coordination, balance, strength, and endurance.
  • 97535: Self-care/home management training: This code trains patients in activities of daily living (ADLs) and home management tasks to improve independence and functional abilities.
  • 97542: Wheelchair management training: This code is used for training patients in wheelchairs, including assessment, fitting, adjustment, and training in mobility skills.

Other codes:

These are the additional CPT codes used in occupational therapy and related fields for various assessments, treatment options, and services:

  • 96110: Developmental screening with a standardized instrument: This code is used for assessing a child's developmental progress using a standardized tool to identify potential developmental delays or concerns.
  • 96127: Emotional/behavioral assessment with a standardized instrument: This code is used for assessing emotional and behavioral issues using a standardized tool to evaluate a patient's mental health status and functioning.
  • 97750: Physical performance test: This code is used to evaluate a patient's physical abilities, such as strength, flexibility, endurance, and balance, through standardized physical performance tests.
  • 97755: Assistive technology assessment: This code assesses a patient's need for assistive technology devices or services, including evaluation, selection, and recommendation of appropriate assistive technology solutions.
  • 97760: Orthotic(s) management and training: This code is used for managing and providing training related to orthotic devices, including assessment, fitting, adjustment, and education on the proper use and care of orthoses.

What is the 8-minute rule?

The 8-minute rule is critical in occupational therapy billing for timed codes. It dictates that only treatment sessions exceeding 8 minutes can be billed for. This rule ensures fair reimbursement for occupational therapy services and therapists' time and expertise in patient care.

Here's how the 8-minute rule translates to billing units:

  • If you spend between 8 and 22 minutes with a patient providing therapeutic exercise (code 97110), you can bill for 1 unit (15 minutes).
  • For sessions lasting 23 to 37 minutes, you can bill for two units (2 x 15 minutes).
  • Billing continues in 15-minute increments. So, 38 to 52 minutes equals three units, and so on.

Example: You deliver manual therapy techniques (code 97140) to a patient for 30 minutes. Since this exceeds the 8-minute minimum, you can bill for two units (2 x 15 minutes).

OT billing process top tips

Optimizing your occupational therapy billing process ensures you get paid correctly. Here are five essential tips:

1. Accurate documentation

Keep detailed notes for each patient session, including the date, time, and duration, the primary procedure code (e.g., 97110 for therapeutic exercise), and the goals addressed in one patient contact (e.g., improving balance).

2. Code selection

Choose the correct CPT code for the service you provided. Refer to the AOTA for a list of current codes to ensure accuracy.

3. Utilize modifiers

Use modifiers to provide extra information about the service. For example, adding modifier -59 for distinct procedures performed on multiple treatment options on the same day can help clarify billing.

4. Stay updated

Keep abreast of coding changes published annually by the AMA to ensure you're using the latest and most accurate codes.

5. Consider using a practice management software

Use specialized software for occupational therapy practices to streamline coding, billing, and claims submission. These tools can save time and reduce errors in the billing process.

Why use Carepatron as your medical billing and coding software?

Managing the complexities of occupational therapy billing can be time-consuming and prone to errors. Carepatron offers a comprehensive solution designed to simplify and optimize your billing processes. Here's how Carepatron empowers occupational therapists:

Carepatron's user-friendly interface simplifies code selection. With features like auto-suggested codes based on your documentation, you can ensure accurate coding with less time spent searching for suitable options.

It goes beyond billing. It offers features for appointment scheduling, patient communication, and practice management. This integrated platform allows you to manage your entire practice with ease.

By using patient contact and leveraging Carepatron's innovative features, occupational therapists can spend less time on administrative tasks and focus on what matters most - providing exceptional patient care.

 occupational therapy billing

Commonly asked questions

What is the billing unit rule?

More broadly, the "billing unit rule" can refer to the general principle that medical services are billed in specific units. These units might be based on time (e.g., 15-minute increments in OT), the number of procedures performed, or even particular codes assigned to different services.

What are common billing mistakes one should avoid?

Common billing mistakes in occupational therapy can cause reimbursement delays and claim denials. Ensure accurate medical and therapy history documentation with details like codes and goals addressed. Avoid incorrect coding and modifier misuse by consulting the AOTA for current guidelines. Stay updated on annual coding changes from the AMA and verify patient insurance coverage before service delivery.

Where can you get a list of OT CPT codes?

The American Occupational Therapy Association (AOTA) provides a comprehensive list of current codes.

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