Occupational Therapy CPT Codes Guide

Occupational therapy evaluation codes 97165-97168

Occupational therapy evaluations are billed with 97165, 97166 and 97167 by complexity, and 97168 for re-evaluation. Complexity rests on the occupational profile, the number of performance deficits assessed and clinical decision-making, not on time alone. Evaluations are untimed and billed once per session.

Timed treatment minutes are counted separately, the same way as in our 8-minute rule guide. Practices building their charge set should read the physical therapy billing guide alongside this article, because payers often apply one therapy policy to both disciplines.

Treatment codes OT practices bill most

97530 (therapeutic activities) and 97535 (self-care and home management training) account for much of outpatient OT volume, with 97110 and 97112 used for exercise and neuromuscular work. Each code describes a distinct skilled intervention; the note must show what the client did and why it required a therapist's skill.

For plan-of-care and visit-limit rules that affect all three therapy disciplines, see our occupational therapy billing services page.

Modifiers and units

Medicare claims for OT services carry the GO modifier, and services furnished in whole or in part by an occupational therapy assistant carry the CQ modifier with the related payment adjustment. Timed units follow the total-time method described in the KX modifier guide once a client's therapy spending approaches the annual threshold.

Fastora reviews unit counting, modifiers and documentation for therapy practices as part of medical coding and claims submission, which reduces the correction work described in how to reduce claim denials.

Frequently asked questions