Occupational Therapy CPT Codes can be overwhelming for therapists, clinics, and billing specialists. Each year, new updates, payer-specific rules, and telehealth expansions add layers of complexity. Getting the codes right isn’t just about compliance; it’s about ensuring accurate reimbursement and keeping your revenue cycle healthy.
Occupational Therapy CPT Codes are part of the Current Procedural Terminology (CPT) system, which standardizes how OT services are documented and billed. Each code represents a specific service, whether it’s an evaluation, therapeutic activity, or specialized treatment.
Correct coding ensures:
Here’s a breakdown of the top OT CPT codes you’ll encounter in clinical practice:
Evaluation & Re-Evaluation
Treatment Codes
Specialized & Other OT Codes
Pro Tip: Always apply the GP modifier for OT services, and check local payer rules for prior authorization requirements.
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Pediatric OTs often use a mix of core therapy and development-focused codes:
Reimbursement varies by payer and region, but here’s a general estimate (based on CMS and private payer trends):
CPT Code | Service | Approx. Reimbursement (per 15 mins) | Notes |
97165 | OT eval, low complexity | $90–$95 | Medicare baseline rate |
97530 | $55–$85 | Higher with GP modifier | |
97535 | Self-care training | $60–$80 | Often requires medical necessity notes |
G0515 | Telehealth OT services | 85–100% of the in-person rate | Medicare & many private payers |
Accurate occupational therapy medical billing and coding is the backbone of a clinic’s financial health. Even the best treatment plans can result in delayed payments if codes are used incorrectly. That’s why many providers turn to professional occupational billing services to handle claim submissions, payer rules, and denial management.
With expert support, therapists can focus more on patient care while ensuring every service is billed correctly and reimbursed on time.
Become skilled at occupational therapy CPT codes isn’t just about billing; it’s about ensuring providers get paid fairly and patients receive uninterrupted care.
If your practice struggles with OT billing errors or denied claims, Cures Medical Billing Services can help. Our team ensures accurate coding, faster reimbursements, and full compliance with 2025 CMS rules.
Contact us today to simplify your OT billing process!
The top 10 OT CPT codes for 2025 include:
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:
Use G0156 (home health OT, per 15 minutes) or S9129 (private payer home care). Ensure your documentation includes homebound status.
Medicare generally covers 80% of approved rates after deductibles. For example, 97530 may reimburse around $70 per 15 minutes, depending on your state.
Common codes include 97535 (self-care training), 97150 (group therapy), and 0373T when ABA and OT are combined for autism support.
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