Occupational therapy billing
Occupational therapy billing that keeps the plan of care and the claim in step
Occupational therapy billing follows the same unit-based structure as physical therapy, with its own evaluation codes, discipline modifier and documentation focus on function and daily activities. OT visits often share a benefit cap with PT and speech therapy.
Built for
- Outpatient OT clinics
- Pediatric OT practices
- Rehab groups offering PT, OT and SLP
Where occupational therapy revenue usually gets stuck
- Shared therapy caps
- OT visits may count against the same annual limit as PT, so visits must be tracked across disciplines.
- Evaluation complexity
- OT evaluations (97165–97167) are selected by complexity and must match documentation.
- Assistant services
- Services furnished by an OTA carry their own modifier and payment rules under Medicare.
What we handle for you
The services that apply to occupational therapy practices, and what each one means in practice.
| Service | For occupational therapy practices |
|---|---|
| Eligibility, benefits and prior authorization | Combined therapy benefits and authorization vendors. |
| End-to-end medical billing | Units, GO modifier and plan-of-care dates. |
| Denial prevention and appeals | Visit-limit and medical necessity denials. |
Claims, coding and authorization details that matter
- GO modifier
- Medicare requires the GO modifier on services delivered under an OT plan of care.
- OTA services
- Medicare requires the CO modifier for services furnished in whole or in part by an occupational therapy assistant.
- Timed codes
- Therapeutic activities, self-care training and similar services are timed codes billed in units.
Our occupational therapy billing workflow
- 1
Verify combined benefits
Check visit caps shared across therapies.
- 2
Plan of care certified
Track certification and recertification.
- 3
Units and modifiers
Check before submission.
Payer coordination
- Pediatric OT may be covered under different benefit categories depending on the plan and diagnosis.
Compliance notes
- Coding statements on this page are general guidance; final code selection depends on documentation and current payer policy.
Occupational therapy billing: questions we hear
Do you bill OT and PT for the same clinic?
Yes. We track visits across disciplines so shared benefit limits are not exceeded unexpectedly.
Related specialties
Primary sources
Content last reviewed . Payer rules change; this page is general information, not legal or coding advice for a specific claim.
Let's look at your occupational therapy revenue cycle
Tell us where payments are getting stuck. In 20 to 30 minutes we'll show you what we'd check first, and tell you plainly if we can help.
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