Occupational Therapy CPT Codes: 2027 Coding and Billing Guidelines

The CPT codes are used for the procedure performed by the occupational therapists such as evaluation, exercises, functional activities, and other services.

However, merely choosing the code associated with a certain procedure is not enough. The person has to justify why this treatment was needed, skilled services performed, client encounter, and the proper length of the performed service.

This paper will review the most popular CPT codes for occupational therapy for 2026, Medicare timed units, modifiers, documentation, and other billing mistakes to avoid.

What Are Occupational Therapy CPT Codes?

The occupational therapy CPT codes are five-character numerical codes which identify the professional services provided by occupational therapists to help patients to enhance their functional capabilities.

• These services could include:
• Functional evaluation and management.
• Strength and coordination improvement.
• Skill development in self-care activities.
• Training on adaptive devices.
• Cognitive rehabilitation.

The CPT code set is updated by the American Medical Association (AMA), and AOTA offers coding resources to the occupational therapy profession.

It should be noted that the CPT codes describe the service offered, while the ICD-10-CM codes describe the medical condition of the patient.

Common Occupational Therapy CPT Codes for 2026

Occupational therapy practices frequently use codes from the 97100, 97500, and 97700 series. The following table highlights common services and their coding purposes.

CPT Code	Service	Billing basis
97165	Low-complexity OT evaluation	Untimed
97166	Moderate-complexity OT evaluation	Untimed
97167	High-complexity OT evaluation	Untimed
97168	OT re-evaluation	Untimed
97110	Therapeutic exercise	15 minutes
97112	Neuromuscular reeducation	15 minutes
97140	Manual therapy	15 minutes
97530	Therapeutic activities	15 minutes
97535	Self-care/home management training	15 minutes
97537	Community/work reintegration	15 minutes
97542	Wheelchair management	15 minutes
97760	Initial orthotic management/training	15 minutes
97763	Subsequent orthotic/prosthetic management/training	15 minutes

These codes are noted in the 2026 reference from AOTA as among those services which OTs usually report. Nevertheless, these codes do not guarantee coverage by all insurance plans.

Occupational Therapy Evaluation CPT Codes: 97165–97168

The evaluation process of an occupational therapist starts with analyzing the occupational profile, medical history, limitations, and rehabilitation objectives of the patient. Based on the complexity of the evaluation, the occupational therapist then uses the proper evaluation code.

CPT 97165: Low-Complexity Evaluation

Code 97165 is to be used for cases that qualify as low complexity.

For instance, an occupational therapist will conduct an assessment on an individual whose hand injury and occupational performance are uncomplicated, and no modifications were made for the test.

CPT 97166: Moderate-Complexity Evaluation

Code CPT 97166 is for an evaluation that satisfies the requirements of a moderate complexity.

Imagine a post-stroke patient who has various functional limitations and needs a more comprehensive assessment of daily activities.

The therapist should assess the deficit and record the clinical decision-making process that will justify this code.

CPT 97167: High-Complexity Evaluation

CPT 97167 should be used if the evaluation is high complexity.

For example, there can be cases where the patient has many problems, deficits and complicated assessment issues; this means that he/she would require many evaluations and a change in the type of assessment. It is important for the therapist to record why there was a need for high complexity.

CPT 97168: Occupational Therapy Re-Evaluation

The CPT 97168 describes a reevaluation under an already existing plan of care.

Reevaluation can be carried out by the therapist in the case when there is a significant change in the patient’s state and the therapist needs to reevaluate his functional ability.

Nevertheless, routine follow-up is not always indicative of the application of this code.

Therapeutic Exercise CPT Code 97110

CPT 97110 refers to therapeutic exercises that involve the enhancement of strength, endurance, flexibility or ROM.

An occupational therapist may charge CPT 97110 for therapy involving the application of therapeutic exercises for overcoming any deficiencies.

The occupational therapist may help in the rehabilitation process of the wrist after surgery through therapeutic exercises.

In documentation of CPT 97110, the exercises, goal, skilled supervision, patient’s response, and treatment time should be described.

Giving an exercise sheet to the patient will not necessarily justify the therapeutic exercises.

CPT 97530 vs. 97535: What Is the Difference?

Both services may help increase a patient’s independence; however, a treatment goal distinguishes the two.

Therefore, it is not unusual for therapists to misinterpret therapeutic procedures for self-care training services.

CPT 97530	CPT 97535
Focuses on dynamic activities that improve functional performance.	Focuses on self-care and home management skills.
May involve reaching, carrying, or functional movement tasks.	CPT 97535 could be used to code this particular service. meal preparation, bathing, or adaptive equipment training.
Requires direct one-on-one contact.	Requires direct one-on-one contact.
Uses 15-minute units.	Uses 15-minute units.

Example in practice: The therapist provides assistance to the client in dynamic reach activities for functional movement. CPT code 97530 could be used for coding this scenario.

Next, the therapist assists the client with adaptive dressing with the aid of adaptive dressing devices. CPT 97535 could be used for coding this specific service.

Both CPT codes can be billed for the same day only if they are different in nature, are medically necessary, and have been properly documented.

Occupational Therapy CPT Code in Addition to 97112 and 97113

There are certain patients who require more than just exercises and activities of daily living.

CPT 97112: Neuromuscular Re-Education

The CPT codes 97112 refer to procedures performed to achieve coordination, movement, balance, posture, and/or proprioception of body parts.

For instance, an occupational therapist may help his/her patient re-educate his/her upper extremity movement because of his/her neurological impairment.

CPT 97140: Manual Therapy

CPT code 97140 stands for correct manual therapy technique which may include joint mobilization and/or manual lymphatic drainage.

The practitioner must decide the area of the body being treated, the procedure done, its intent, and the time of the skilled procedure.

CPT 97760 and 97763: Orthotic Management

CPT 97760 is for the initial orthotics management and training, which includes the qualification evaluation and fitting.

CPT 97763 is for the subsequent orthotics or prosthetics management and training.

In other words, the patient comes back for additional orthotics training following the initial encounter. It is up to the therapist to find out whether the service qualifies as a subsequent-encounter code.

CPT 97542: Wheelchair Management

CPT 97542 can be used by therapists to perform assessments, fittings, and training for wheelchairs.

The documentation should include a discussion on how the functional limitation affects skilled intervention.

How Medicare’s 8-Minute Rule Works for Occupational Therapy

Medicare utilizes the 8-minute rule in determining the billable units of the relevant 15-minute timed therapy services.

In this case, the billing staff calculates the total minutes for qualified treatments within timed codes and assigns units based on such services.

Medicare timed-service unit reference

8–22 minutes	1 unit
23–37 minutes	2 units
38–52 minutes	3 units
53–67 minutes	4 units
68–82 minutes	5 units

These ranges describe aggregate timed treatment minutes under Medicare’s applicable outpatient therapy methodology, not automatic units for every individual code.

Medicare Part B illustration. Code allotment, skilled services, assistants, and payers’ policies have to be reviewed.

For instance, therapeutic exercise for 20 minutes, and therapeutic activities for 18 minutes total 38 minutes, which allow for three units according to Medicare calculations. Minutes specific for each code used by the therapist become the criteria for the final allotment.

Medicare makes a distinction between timed services and untimed evaluations. Thus, evaluation minutes need to be excluded from the minutes that calculate timed units.

Medicare Modifiers for Occupational Therapy Billing

Modifiers communicate important information about the therapy plan, professional involvement, and applicable billing conditions.

Modifier	Purpose
GO	Identifies services under an occupational therapy plan of care
CO	Identifies applicable OT services involving an occupational therapy assistant
KX	Indicates that services meet applicable medical necessity requirements after reaching the Medicare therapy threshold
59	Identifies a distinct procedural service when coding rules support its use
GN	Identifies services under a speech-language pathology plan of care
GP	Identifies services under a physical therapy plan of care

In the year 2026, CMS designates a threshold of $2,480 for OT using Medicare KX modifier, independent of the PT and SLP threshold which is also $2,480.

The threshold for targeted medical review in the same year is $3,000, which, when crossed, will not result in coverage being terminated for the OT service.

Besides, there are certain guidelines of Medicare regarding the CO modifier, especially when an occupational therapy assistant performs some qualifying portions of services.

Occupational Therapy vs. Physical Therapy and Speech Therapy CPT Codes

Rehabilitation clinics may offer occupational therapy, physical therapy, and speech-language pathology services within the same facility. Nevertheless, billing staff must distinguish each professional discipline and treatment plan.

Discipline	Common CPT codes	Primary focus
Occupational therapy	97165, 97530, 97535	Daily activities, occupational performance, functional independence
Physical therapy	97161, 97110, 97112	Movement, strength, mobility, physical rehabilitation
Speech-language pathology	92507, 92523, 92526	Speech, language, communication, swallowing

Code PT CPT depends on the physical therapy procedure that needs to be carried out. For example, the code 97110 may indicate qualified therapeutic exercises in occupational as well as physical therapy.

Furthermore, codes for speech pathology also depend on the evaluation and treatment procedure that is performed.

Major update to come: CPT 92507 is valid till December 31, 2026. However, from January 1, 2027, an entirely new set of codes for speech-language pathology treatments will replace CPT 92507.

Common Occupational Therapy Billing Errors and How to Prevent Them

Even if correct codes are selected, this is not enough to cover incomplete documentation or lack of payer requirements.

Wrong Time Calculations

Some medical billing staff round up every 15-minute service or consider the whole appointment to be a billable therapy time.

On the contrary, one should track the actual therapy time spent and apply the right payer’s unit methodology.

Evaluation Complexity Without Support

Just because the appointment was long does not mean that it was a complex evaluation.

OTs need to document the occupational profile, findings, deficits and clinical reasoning behind selecting this complexity level.

Medical Necessity Not Present

A diagnosis might be insufficient in explaining why occupational therapy is necessary for the patient.

It is thus advisable to relate limitations to treatment goals and justify professional intervention through documentation.

Wrong Usage of Modifiers

Absence of GO modifier and usage of incorrect CO modifier will cause problems when billing Medicare.

Ensure you have the correct discipline of therapy, assistant participation, and Medicare requirements prior to billing.

Issues Regarding Authorization and Coverage

Some private health insurance companies need prior authorization or visit/therapy restriction.

Check eligibility, benefits, authorization, and visits before commencing therapy where these requirements are needed by the company.

Documentation Checklist for Cleaner OT Claims

The ideal occupational therapy document will assist in making the reviewer aware of the nature of therapy provided and the necessity for it.

Before submitting a claim, ensure that the clinical record includes:

• The diagnosis of the patient and his/her limitations.
• An assessment as well as treatment approach.
• Rehabilitation goals.
• The therapy and its CPT code.
• The direct minutes of treatment if any.
• Improvement in function.
• Therapist signatures.

Furthermore, billing managers should verify NCCI edits, provider enrollment data, place of service information, and payer coverage policies.

If the claim fails the edit, then investigate the issue with the code rather than just attaching modifier 59 to the claim.

Practical Strategies to Improve Occupational Therapy Claims

By developing an effective review system, occupational therapy billing professionals could avoid many mistakes in their claims that are easily fixable.

Initially, it is necessary to correlate templates for documentation with the services provided by the therapists. Second, it is needed to correlate all timed procedures with minutes of treatment and the purpose of the procedure itself.

Also, it is possible to develop a system of monitoring of bills on the basis of the following criteria: the presence of GO modifiers, unusual sums of units, and authorization issues. It is possible to perform audits of claims with complexities of evaluation, therapy and involvement of assistants in the treatment process.

It is also imperative that the denial be categorized by reason. For instance, a pattern of denials of medical necessity may imply that there is a documentation issue, while a pattern of denials relating to authorizations suggests an office workflow problem.

Frequently Asked Questions

1. What is the most common CPT code for occupational therapy?

Occupational therapists use some of the following common CPT codes: 97110 is for therapeutic exercises; 97530 is for therapeutic activities; and 97535 is for self-care training. This will depend on what you do in your practice.

2. What CPT code denotes occupational therapy evaluation?

For low complexity evaluations we have 97165 CPT code, for moderate complexity – 97166 and for high complexity evaluations we have 97167 CPT code. 97168 CPT code is used for qualifying re-evaluation.

3. Is 97110 CPT code for occupational therapy or physical therapy?

Both may use 97110 for qualifying therapeutic exercises. However, if you bill to Medicare, you need to use the correct discipline modifier GO (for OT) or GP (for PT).

4. What is the CPT code for occupational therapy self-care training?

Qualifying self-care and home management training is defined by 97535 CPT code.

5. Are both CPT codes 97530 and 97110 reportable by OTs?

Yes, provided that distinct interventions, as well as time spent on each service, are performed, documented, and all other payer guidelines are satisfied. NCCI edits could also come into play.

6. Which modifier is required by Medicare for OT?

Medicare typically requires the GO modifier in the setting of outpatient services based on an occupational therapy treatment plan. Other modifiers, including CO and KX, could also be needed depending on certain conditions.

7. Does Medicare provide OT past the KX threshold?

Yes, if occupational therapy is medically necessary over the threshold, Medicare may still provide reimbursement.

Conclusion

Correct Occupational Therapy Billing begins with identifying the appropriate CPT code for the provided treatment intervention. Such factors as evaluation level, number of minutes for direct patient treatment, possible modifiers, and payer requirements may affect the way the claims should be prepared by the practice.

This information will allow healthcare practitioners to detect incorrect coding before submission and prove the medical necessity.