Billing Codes for Occupational Therapy Simplified
Over the last few weeks on the blog, we have addressed many of the issues associated with billing for Physical Therapy. While these are certainly important issues to address (especially with regard to the recent changes in the ICD-10 codes for physical therapy), other therapy specialties have billing concerns as well. Occupational Therapists, for example, must also abide by CPT codes when documenting treatment and oftentimes it is more difficult for OTs to achieve reimbursement. In today’s post, we will look at some of the most commonly used CPT codes by Occupational Therapists, and when they should be used as well as how the 8-minute rule applies to OTs.
CPT Codes for Occupational Therapy: What are they?
In medical terminology, CPT codes (Current Procedural Terminology) describe a variety of medical procedures. They serve as a standardized format for healthcare providers and are helpful for billing and documentation purposes. In occupational therapy, there are limitless interventions available since occupational therapists help clients meet meaningful goals. In selecting a CPT code for occupational therapy services, it is important to consider the therapeutic goal. A variety of interventions can be covered by CPT codes because they are general.
Common Occupational Therapy CPT Codes
Most occupational therapy treatment codes are based on time, except for group therapy (CPT Code 97150). Occupational therapy services are commonly coded as follows.
CPT CODE 97110 Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion, and flexibility
CPT CODE 97112 Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities
CPT CODE 97113 Aquatic therapy with therapeutic exercises
CPT CODE 97116 Gait training (includes stair climbing)
CPT CODE 97124 Massage, including effleurage, petrissage, and/or tapotement (stroking, compression, percussion)
CPT CODE 97129 Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes
CPT CODE 97139 Unlisted therapeutic procedure (specify)
CPT CODE 97140 Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction) 1 or more regions, each 15 minutes
CPT CODE 97150 Therapeutic procedure(s), group (2 or more). It is important to note that group therapy is not based on time and is reported for each member of the group)
CPT CODE 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes
CPT CODE 97633 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 [ADLs] 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, use of assistive technology device/adaptive equipment), direct one-on-one contact, each 15 minutes
CPT CODE 97542 Wheelchair management (e.g., assessment, fitting, training), each 15 minutes
CPT CODE 97545 Work hardening/conditioning; initial 2 hours
CPT CODE 97546 Each additional hour (List separately from code for primary procedure.)
Occupational Therapy Evaluation Codes
Client need is taken into account when determining occupational therapy evaluation codes. If the assessment is problem-focused and the outcome has a limited number of treatment options, the low complexity code should be used if the client has 1-3 performance deficits and a brief medical history.
The criteria for using each CPT code change as the complexity of the evaluation increases. An evaluation of moderate complexity requires a detailed assessment, medical history, and occupational profile for a client with 3 to 5 performance deficits. A modified assessment may be needed for this client as there may be several treatment options.
It is essential to conduct a complete occupational therapy assessment, review a medical history, and develop an occupational profile for a high complexity occupational therapy evaluation. There are at least five performance deficits for this client. It may be necessary to modify an occupation-based assessment significantly. It is necessary to document changes in performance, medical status, and occupational profile when using the re-evaluation code. An updated plan of care should be included in the re-evaluation.
CPT CODE 97165 Occupational therapy evaluation, low complexity
CPT CODE 97166 Occupational therapy evaluation, moderate complexity
CPT CODE 97167 Occupational therapy evaluation, high complexity
CPT CODE 97168 Occupational therapy re-evaluation
Eight-minute rule for billable minutes in Occupational Therapy
Although many CPT codes are given in 15-minute increments, recent changes in billing structure apply to occupational therapy. CMS (Centers for Medicare and Medicaid) created an 8-minute rule to determine how to use units when sessions are not exactly 15 minutes long. Therapy units lasting at least eight minutes are allowed to be billed according to the 8-minute rule. This guideline is also followed by some private payers. Get more information from your individual payor.
8-22 minutes = 1 unit
23-37 minutes = 2 units
38-52 minutes = 3 units
53-57 minutes = 4 units
Private practice use of CPT codes
Occupational therapy services can be summarized using CPT codes in a way that can be reimbursed by insurance companies. Payment for the services rendered must be confirmed with the payer. There are updates to CPT codes on an annual basis, and you should review any changes with your professional association or the American Medical Association.
Using practice management software, CPT codes can be managed. Using PatientStudio, therapists can save codes and have them auto-populated on the correct forms for billing. Schedule a demo of PatientStudio for your Occupational Therapy Clinic today.