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Specialized Occupational Therapy Billing Solutions

Occupational therapy billing requires meticulous attention to CPT coding, functional documentation, and payer-specific rules for activities of daily living (ADL), sensory processing, and pediatric therapies. Incorrect coding or insufficient documentation can lead to claim denials, audits, and significant revenue loss.

Our team specializes in OT-specific billing, ensuring your practice receives accurate reimbursements while maintaining full compliance with Medicare, Medicaid, and private insurers.

Key Occupational Therapy Billing Services We Handle

✅ Evaluations & Re-evaluations (97165-97168) – Proper complexity level documentation
✅ Therapeutic Activities (97530) – ADL training and functional rehabilitation
✅ Sensory Integration (97533) – Billing for sensory processing treatments
✅ Neuromuscular Re-education (97112) – Restoring functional movement
✅ Group Therapy (97150) – Compliance with payer-specific requirements
✅ Cognitive Skills Development (97129) – Billing for cognitive rehab
✅ Chronic Care Management (G0515) – Medicare billing for ongoing care

Top OT Billing Challenges & How We Solve Them

1. ADL Training Documentation (97530)

  • Must demonstrate medical necessity through functional goals

  • Requires detailed progress notes showing patient improvement

  • Common denial: “Service not medically necessary”

  • Our Solution: We ensure documentation clearly links treatment to functional outcomes

2. Sensory Integration Billing (97533)

  • Must differentiate from general OT services

  • Requires specific assessment documentation (e.g., SPM, Sensory Profile)

  • Many payers require pre-authorization

  • Our Solution: We verify coverage and document medical necessity upfront

3. Pediatric OT Billing Complexities

  • School-based vs. clinic-based billing differences

  • Handling Early Intervention (EI) programs

  • Medicaid vs. private insurance variations

  • Our Solution: We navigate all pediatric billing scenarios

4. Modifier Requirements

  • Modifier 59 for distinct services

  • Modifier GP for outpatient therapy services

  • Modifier KX for Medicare therapy cap exceptions

  • Our Solution: Proper application to prevent denials

Why Choose Our OT Billing Services?

🔹 OT-Specific Expertise – We understand the nuances of occupational therapy billing
🔹 Reduced Denials – Our pre-submission audits catch 95% of potential errors
🔹 Maximized Reimbursements – We ensure all billable services are captured
🔹 Compliance Assurance – Stay protected against audits and takebacks
🔹 Transparent Reporting – Monthly performance analytics