Important CPT Codes for Occupational Therapy Evaluation

by | Published on Jun 5, 2023 | Specialty Billing, Specialty Coding

Occupational Therapy Evaluation
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Occupational therapy evaluations are an essential part of helping patients regain their independence and improve their quality of life. However, accurately documenting these evaluations can be a daunting task, especially when it comes to coding. CPT (Current Procedural Terminology) codes are used by healthcare professionals to accurately document and bill for their services. With hundreds of codes available, it is rather challenging to know which ones are the most essential for accurate documentation. It is ideal to consider the services of professional medical billing outsourcing companies to ensure clean submission of claims. In this blog, we look at the most important CPT codes for accurate occupational therapy evaluations.

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CPT Codes for Occupational Therapy

Occupational therapy evaluations are documented using Current Procedural Terminology (CPT) codes. The specific CPT codes used for occupational therapy evaluation may vary depending on the nature and complexity of the evaluation.

Here are some important CPT codes commonly used for occupational therapy evaluation:

  • 97165 Occupational therapy evaluation, low complexity (typically 30 minutes)
  • 97166 Occupational therapy evaluation, moderate complexity (typically 45 minutes)
  • 97167 Occupational therapy evaluation, high complexity (typically 60 minutes)
  • 97168: Occupational therapy re-evaluation

These codes represent different levels of complexity and the time spent on the evaluation. The choice of the appropriate code depends on factors such as the patient’s condition, the complexity of the evaluation, and the time spent by the occupational therapist in conducting the evaluation.

With the exception of group therapy (CPT Code 97150), OT treatment codes are based on time, most commonly in 15-minute units.

Other commonly used codes for occupational therapy services are –

  • 97110 Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion, and flexibility
  • 97112 Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities
  • 97113 Aquatic therapy with therapeutic exercises
  • 97116 Gait training (includes stair climbing)
  • 97124 Massage, including effleurage, petrissage, and/or tapotement (stroking, compression, percussion)
  • 97129 Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes
  • 97139 Unlisted therapeutic procedure (specify)
  • 97140 Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction) 1 or more regions, each 15 minutes
  • 97150 Therapeutic procedure(s), group (2 or more). It is important to note that group therapy is not based on time and is reported for each member of the group)
  • 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes
  • 97533 Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes
  • 97537 Community/work reintegration training (e.g. shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technology device/adaptive equipment), direct one-on-one contact, each 15 minutes
  • 97542 Wheelchair management (e.g., assessment, fitting, training), each 15 minutes
  • 97545 Work hardening/conditioning; initial 2 hours
  • 97546 Each additional hour (List separately in addition to code for primary procedure.) This code is designed to be used with 97545.

It’s important to note that these codes are subject to updates and revisions by the American Medical Association (AMA) and insurance payers. Professional medical coding companies stay current with the recent CPT code manual to provide up-to-date coding information for occupational therapy evaluations. Additionally, documentation should support the medical necessity and complexity level of the evaluation to ensure appropriate billing and reimbursement.

Accurate coding is crucial in occupational therapy evaluations, as it ensures that therapy services are properly documented and billed. This, in turn, ensures that therapy services are reimbursed correctly and that patients receive accurate statements of their healthcare expenses. Properly documenting occupational therapy evaluations can also help with patient care, as it provides a clear record of the therapy provided and the progress made by the patient.

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Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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