Occupational Therapy Billing Services
Occupational therapy billing lives or dies on unit math. Treatment codes are timed in 15-minute units, evaluations are untimed, and the number of units on a claim is decided by a single rule applied to the day’s total timed minutes. Apply the rule per code instead of per day, or count untimed evaluation minutes as timed treatment minutes, and the claim will underpay or deny. Add the therapy modifier, the plan of care, and payer-specific unit rules, and a simple visit becomes a surprisingly technical claim.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for occupational therapy practices, built around the specialty’s actual code families and payer requirements.
Occupational Therapy billing challenges
The first distinction is timed versus untimed. Timed treatment codes include 97110 for therapeutic exercise, 97112 for neuromuscular reeducation, 97140 for manual therapy, 97530 for therapeutic activities, and 97535 for self-care and home management training. These are billed in 15-minute units. Evaluations are untimed and billed once per session regardless of time: 97165 for low complexity, 97166 for moderate complexity, and 97167 for high complexity, with 97168 for re-evaluation when the patient’s condition changes significantly.
Medicare’s 8-minute rule converts total timed minutes into billable units. The rule is applied once to the day’s total timed minutes, not once per code: 8 to 22 minutes supports 1 unit, 23 to 37 minutes supports 2 units, 38 to 52 minutes supports 3 units, 53 to 67 minutes supports 4 units, and the pattern continues in 15-minute steps. A service provided for fewer than 8 minutes cannot be billed as a standalone unit, though those minutes still count toward the day’s total. Leftover minutes from different timed codes can be pooled under Medicare’s method to justify the last unit of the day. Some commercial payers use a different method, sometimes called the rule of eights, where each code must reach 8 minutes on its own, and billing those claims with Medicare’s pooling method produces unit counts the payer will deny.
Outpatient occupational therapy claims to Medicare require the GO modifier to identify the discipline, and the claim must be supported by a plan of care with documented goals, progress notes, and medical necessity for continued treatment. Group therapy, reported with 97150, is billed per patient and follows its own rules. Documentation must record the skilled nature of each intervention, the time spent on timed codes, and the patient’s response, because therapy claims are a frequent target for medical review.
What MedPlus RCM handles for Occupational Therapy practices
- End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
- Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
- Provider credentialing and enrollment. End-to-end enrollment with commercial payers and Medicare, plus re-credentialing maintenance.
- Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
- A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
- Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
We serve occupational therapy practices nationwide, including outpatient clinics, hospital-based departments, school-based programs, and home health therapy teams.
Results Occupational Therapy practices can check
MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.
Frequently asked questions
What is the 8-minute rule?
Medicare’s rule for converting timed treatment minutes into units. The day’s total timed minutes decide the units: 8 to 22 minutes is 1 unit, 23 to 37 is 2 units, 38 to 52 is 3 units, and the pattern continues in 15-minute steps.
Are occupational therapy evaluations timed codes?
No. Evaluations (97165 through 97167) and re-evaluation (97168) are untimed and billed once per session regardless of how long they take. Only treatment codes are timed.
What is the GO modifier?
The GO modifier identifies occupational therapy services on outpatient claims to Medicare. It must appear on the claim lines for therapy services billed to Medicare.
Why do our units deny with some commercial payers but not Medicare?
Some commercial payers apply a per-code rule of eights instead of Medicare’s pooled-minutes method. Under that method each code must reach 8 minutes on its own, so unit counts that pass Medicare’s method can fail with those payers.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.
Get a free financial audit
Find out where your occupational therapy practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
