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Occupational Therapy CPT Codes - 2025 Billing & Reimbursement Guide

Name: Cures Medical Billing Services Company
Address: 3811 Ditmars Blvd# 1124, Astoria, NY 11105, Astoria, NY, 11105, USA
Telephone: +1 (917) 994-9941

Key Takeaways

CPT codes standardize OT billing, preventing denials and securing reimbursement.
Top OT codes in 2025 include evaluations (97165–97168), therapeutic activities (97530), and self-care training (97535).
Pediatric & autism OT billing may require group therapy or ABA collaboration codes.
Reimbursement rates vary, so check CMS updates and payer contracts annually.

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.

What Are Occupational Therapy CPT Codes?

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:

Faster claim approvals
Reduced denials or audits
Proper reimbursement for OT providers

Most Common Occupational Therapy CPT Codes in 2025

Here’s a breakdown of the top OT CPT codes you’ll encounter in clinical practice:

Evaluation & Re-Evaluation

97165 – OT evaluation, low complexity
97166 – OT evaluation, moderate complexity
97167 – OT evaluation, high complexity
97168 – Re-evaluation of OT plan of care

Treatment Codes

97110 – Therapeutic exercises (strength, ROM, flexibility)
97112 – Neuromuscular re-education (balance, coordination)
97530 – Therapeutic activities (motor skills, adaptive tasks)
97535 – Self-care/home management training
97140 – Manual therapy techniques (mobilization, soft tissue)

Specialized & Other OT Codes

97755 – Assistive technology assessment
97760 – Orthotic management and training
97761 – Prosthetic training
G0515 – Telehealth OT services (Medicare)
0373T – Autism-related ABA + OT collaboration

Pro Tip: Always apply the GP modifier for OT services, and check local payer rules for prior authorization requirements.

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Pediatric & Autism-Related OT CPT Codes

Pediatric OTs often use a mix of core therapy and development-focused codes:

97150 – Group therapy (common in autism programs)
97535 – Self-care training (ADL skills for children with autism)
0373T – Applied Behavior Analysis (ABA) combined with OT interventions

Reimbursement Rates for OT CPT Codes in 2025

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	Therapeutic activities	$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

Common OT Billing Mistakes to Avoid

Mixing PT & OT codes – Always use GP modifier for OT, GN for speech, GO for PT.
Incomplete documentation – Write measurable outcomes, e.g., “patient increased grasp strength from 3 lbs. to 7 lbs.
Ignoring payer-specific telehealth rules – Some require modifier “95” or “GT.”
Not updating codes yearly – CMS updates OT fee schedules annually.

Why Occupational Therapy Medical Billing and Coding Matters

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.

Final Thoughts

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!

Frequently Asked Questions (FAQs)

What are the most used occupational therapy CPT codes in 2025?

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).

How do I choose between 97165, 97166, and 97167 for evaluations?

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).

Can I bill 97110 and 97530 together?

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.

What’s new in OT CPT Codes for 2025?

Key updates:

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

How do I bill for group therapy vs. individual sessions

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

What modifiers are essential for OT billing?

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

How do I bill for home health OT services?

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

How much does Medicare reimburse for OT CPT codes?

Medicare generally covers 80% of approved rates after deductibles. For example, 97530 may reimburse around $70 per 15 minutes, depending on your state.

What CPT code is used for occupational therapy for autism?

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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