Every unit documented, every unit billed.
Occupational therapy shares the therapy threshold and the timed-code rules with physical therapy, but it has its own evaluation codes, its own modifier, and its own denial patterns. OT claims get scrutinized on medical necessity more than most, and the difference between a paid claim and a denied one usually lives in the documentation.
Low, moderate, and high complexity evaluations each have specific documentation requirements around occupational profile, performance deficits, and clinical decision making. We review evaluations against those requirements so the level billed holds up.
Every OT claim to Medicare needs the GO modifier, and OT has its own annual therapy threshold separate from the combined PT and speech threshold. We track each patient against it and apply KX with supporting documentation before claims go out.
The 8-minute rule governs OT the same way it governs PT. We audit units on 97530 therapeutic activities, 97535 self-care training, 97110, and every timed code so you bill the maximum defensible units on every visit.
When an occupational therapy assistant furnishes more than ten percent of a service, Medicare requires the CO modifier and pays at a reduced rate. Getting this wrong in either direction is costly. We track assistant participation per service and apply it correctly.
Custom orthotic fabrication, splinting, and hand therapy carry their own codes, their own supply billing, and their own coverage rules. We make sure the fabrication work and materials get billed, not absorbed.
We know every code you bill: 97165-97168 evaluations and re-evaluation, 97530 therapeutic activities, 97535 self-care and home management training, 97110 therapeutic exercise, 97112 neuromuscular re-education, 97140 manual therapy, and orthotic and prosthetic management codes.
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