The Ultimate Guide to Occupational Therapy CPT Codes & Billing

The top 10 OT CPT codes for 2025 include:

• 97165(OT evaluation, low complexity)
• 97166(OT evaluation, moderate complexity)
• 97167(OT evaluation, high complexity)
• 97110(Therapeutic exercise)
• 97112(Neuromuscular reeducation)
• 97530(Therapeutic activities)
• 97535(Self-care/home management training)
• 97760(Orthotic management & training)
• 97763(Prosthetic training)
• G0515(Telehealth OT services, Medicare).

• 97165: Low complexity (e.g., 1-2 functional deficits, straightforward goals).
• 97166: Moderate complexity (e.g., multiple deficits, standardized tests).
• 97167: High complexity (e.g., comorbidities, interdisciplinary coordination).

Yes, but only if services are distinct (e.g., therapeutic exercise for strength and therapeutic activities for functional training). Use modifier 59 if required by payers.

Key updates:

• Telehealth: Expanded use of G0515for Medicare.
• Documentation: Stricter requirements for medical necessity.
• Reimbursement: Slight increases for timed codes (e.g., 97535).

• Individual: Use standard codes (e.g., 97110).
• Group (2+ patients): Use 97150(group therapy).

• GP: Identifies OT services (Medicare/private payers).
• KX: Signals meeting medical necessity thresholds.
• 59: Distinct procedural service (if applicable).

Use G0156 (home health OT, per 15 minutes) or S9129 (private payer home care). Ensure your documentation includes homebound status.