CPT codes occupational therapy, including 8-minute rule; 20 common CPT codes for occupational therapy (e.g., CPT code 97100) and resources will be covered in this blog.
What are CPT Codes Occupational Therapy?
A CPT® (Current Procedural Terminology) code is a numerical code that is used to describe a variety of medical services. These five-digit numbers create a standardized format for healthcare providers and are helpful for documentation and billing. Since occupational therapists focus on helping clients meet goals that are meaningful to them, there are limitless interventions that can be used in occupational therapy. When selecting an CPT code for occupational therapy services, it is important to consider what the therapeutic goal is. CPT codes are general so they can cover a variety of different interventions.
Treatment CPT Codes for Occupational Therapy
With the exception of group therapy (CPT Code 97150), OT treatment codes are based on time, most commonly in 15-minute units. Below are examples of codes that are commonly used for occupational therapy services.
CPT CODE 97110 Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion, and flexibility
CPT CODE 97112 Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities
CPT CODE 97113 Aquatic therapy with therapeutic exercises
CPT CODE 97116 Gait training (includes stair climbing)
CPT CODE 97124 Massage, including effleurage, petrissage, and/or tapotement (stroking, compression, percussion)
CPT CODE 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
CPT CODE 97139 Unlisted therapeutic procedure (specify)
CPT CODE 97140 Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction) 1 or more regions, each 15 minutes
CPT CODE 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)
CPT CODE 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes
CPT CODE 97633 Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes
CPT CODE 97535 Self-care/home management training (e.g., activities of daily living [ADLs] and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment), direct one-on-one contact, each 15 minutes
CPT CODE 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
CPT CODE 97542 Wheelchair management (e.g., assessment, fitting, training), each 15 minutes
CPT CODE 97545 Work hardening/conditioning; initial 2 hours
CPT CODE 97546 Each additional hour (List separately in addition to code for primary procedure.) This code is designed to be used with 97545
Evaluation Codes for Occupational Therapy
Occupational therapy evaluation codes are based on level of client need. A therapist should use the low complexity code if the client has 1-3 performance deficits, a brief medical history and occupational profile, if the assessment is problem-focused and the outcome has a limited number of treatment options. As the complexity of the evaluation increases, the criteria to use each CPT® code changes. For a moderate complexity evaluation a client may have 3-5 performance deficits, and require a detailed assessment, medical history and occupational profile. There may be several treatment options for this client and modifications may need to be given to administer the assessment. A high complexity occupational therapy evaluation requires a comprehensive assessment, medical history and occupational profile. This client has five or more performance deficits. Significant modification of an occupation-based assessment may be needed. When using the re-evaluation code, an assessment of changes in performance, medical status, and occupational profile must be documented. The re-evaluation should include an updated plan of care.
CPT CODE 97165 Occupational therapy evaluation, low complexity
CPT CODE 97166 Occupational therapy evaluation, moderate complexity
CPT CODE 97167 Occupational therapy evaluation, high complexity
CPT CODE 97168 Occupational therapy re-evaluation
Billable Minutes: 8 Minute Rule
Many CPT® codes are given in units of 15 minutes. In order to determine correct usage of units when a session that is not exactly 15 minutes, CMS (Centers for Medicare and Medicaid) created an 8-minute rule. This 8-minute rule allows therapists to bill for a unit that lasts at least eight minutes. Some private payers also follow this guideline. Check with your individual payors for more information.
8-22 minutes = 1 unit
23-37 minutes = 2 units
38-52 minutes = 3 units
53-57 minutes = 4 units
Use of CPT codes in your Private Practice
CPT codes are a helpful way for occupational therapists to summarize the many services we provide in a way that is reimbursable. It is important to verify with the payer that they will pay for the services rendered. CPT® codes are updated on a yearly bases and it is important to review any changes through the American Medical Association or your professional association.
CPT codes can be managed through a practice management software. TheraPlatform allows therapists to save codes and auto-populate to the CMS-1500 form. Additional features include HIPAA-compliant video conferencing software, an interactive whiteboard, and practice management tools. Try TheraPlatform for free for 30 days.