Occupational Therapy Billing Services
Timed treatment codes, the GO modifier, therapy threshold tracking and plan-of-care certification.
Occupational therapy is billed in timed units against a plan of care. Two things then decide whether a visit pays: the minute arithmetic, and the certification dates. A lapsed certification denies every claim after it, and the denial reason rarely says so plainly. Our occupational therapy billing services track certification and recertification for each patient ahead of the visit.
OT also needs the GO modifier. That shows the service was given under an occupational therapy plan of care. And some payers put pediatric OT under a developmental benefit with completely different authorization rules. We set both per payer at go-live.
Our Services
Many Settings, Many Code Sets
Occupational therapy covers a wide range of settings, and each one has its own codes and its own billing rules. That causes confusion, wrong codes and amounts that move around. Insurers notice quickly, and the claims are denied.
We put specialists on each part of occupational therapy. That is what stops the leaks, and it is where your extra profit comes from.
What benefits are provided by our Occupational Therapy Billing and Coding Services?
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Cautious Selection
Picking the right specialty for a claim matters more than it sounds. Code a procedure to the wrong specialty and you waste your time and ours. Worse, it interrupts the money coming in. One claim can be the difference for a practice in a tight month.
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Subject Matter Experts
Our coders and billers know the occupational therapy billing services codes and the rates that go with them. They have billed across the different OT settings, and that experience is what you are buying.
Occupational therapy services we bill
Our occupational therapy billing covers the full range of settings, with coders who know each one:
- quatic Therapeutic Exercise
- Assistive Technology
- Autism
- Brain Injuries
- Diabetes
- Driving and Community Mobility
- Environmental Modification
- Feeding, Eating, and Swallowing
- Gerontology
- Hand therapy
- Hippotherapy
- Low Vision
- Lymphedema
- Mental Health
- Neuro-developmental Treatment
- Pediatrics
- Physical rehabilitation
- Saebo
- School Systems
- Seating and Mobility Specialist
- Stroke Rehabilitation
- Clinical Anxiety Treatment
How occupational therapy claims are paid
Occupational therapy is billed on time, on complexity and on a plan of care, and each of the three is checked separately.
The evaluation has three levels
There is no single OT evaluation code. There are three, for low, moderate and high complexity, and a fourth for a re-evaluation. The level is decided by the occupational profile, the number of performance deficits, and how much clinical decision making the case needed.
Practices that bill the same level for every patient are the easiest thing for a payer to spot. It is also usually costing them money, because complex patients are being billed at the low level far more often than the reverse.
Timed units and the eight minute rule
Timed treatment codes are billed in fifteen minute units, counted on total treatment time rather than by rounding each code on its own. A single unit needs at least eight minutes and two units need at least twenty three. Rounding each service separately overbills without anyone intending it.
Untimed codes are one unit per visit however long they take. Most unit errors come from mixing the two ways of counting in one session.
The plan of care
Treatment is payable under a plan certified by a physician or qualified practitioner and recertified on schedule. The plan has to name the diagnosis, the long term goals, the type of treatment, the amount, the frequency and the duration. Missing frequency and duration is the most common reason a therapy record fails review.
Documenting function, not activity
The note that supports continued treatment describes what the patient can now do that they could not do before, in terms someone can measure. Lists of activities performed do not support medical necessity. Neither does a statement that the patient is improving with nothing behind it.
Once a patient passes the annual therapy threshold, the claim needs the KX modifier, which is an attestation that the record supports continued care. It is a statement about your documentation, not a switch that unlocks payment.
Occupational Therapy Credentialing
OTs enroll with Medicare on the same private-practice basis as physical therapists. They appear in most of the same commercial networks too. For a large share of that business the network is run by a manager such as Optum Physical Health or American Specialty Health, not by the health plan itself. Applications sent to the plan are not passed on.
Two points are specific to OT. Some plans put pediatric OT under a developmental or behavioral benefit, with different authorization rules. And hand therapy sometimes needs a separate credential before a payer will recognize it. See physical therapy, OT and speech credentialing services.