Occupational Therapy Billing

Occupational therapy is judged on function: payers pay for documented progress toward independence in daily activities, and deny skilled-sounding care that reads as maintenance. Elite Bill Care's occupational therapy billing keeps OT claims aligned to that standard.

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OT billing specifics

• GO modifier on Medicare outpatient OT services, with KX above the annual threshold where documentation supports continued medical necessity.
• Evaluation complexity — 97165–97167 chosen by documented complexity: history, occupational profile, assessment and decision-making.
• Timed treatment codes — therapeutic activities (97530), ADL training (97535), neuromuscular re-education (97112) and others, unit-counted under the 8-minute rule with notes that match.
• Functional documentation — goals written in functional terms and progress measured against them; this is what survives medical-necessity review.
• Shared and separate caps — commercial caps sometimes combine OT with PT/speech; verified per plan at intake.

How we run it

Eligibility and caps are verified up front, units reconciled against treatment minutes at charge entry, plan-of-care certifications tracked alongside PT where both disciplines treat the same patient, and medical-necessity denials appealed with the functional record through denial management. See our billing services for the full operation.

Frequently asked questions