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Practice Essentials

Coding and billing resources

Get paid for the services you deliver. AOTA provides clear, easy-to-understand resources that will help you code and bill correctly. Still have questions?

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Bill with confidence

AOTA members now have access to AOTA’s Medicare Fee Schedule Calculator, designed to help navigate the complexities of Medicare reimbursement, allowing you to determine payment for your services in one convenient location.

Discover how much your services are worth
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Occupational therapy evaluation and re-evaluation codes

Coding is essential not only for proper reimbursement, but also because it is used as a tracking tool by CMS and other agencies to inform how occupational therapy is practiced. These tips will help you select the most appropriate evaluation codes.

Evaluation and Re-Evaluation Codes
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Diagnosis coding resources

The ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) system, replaced the ICD-9-CM (9th Revision) on October 1, 2015. AOTA developed the following resources to help occupational therapists deal with the continuing challenges of ICD-10-CM.

The treating diagnosis is not always the primary medical diagnosis. Use the diagnosis that most appropriately describes the condition you are treating. More than one diagnosis may be appropriate. Do include any comorbidities that are affecting treatment. If possible, avoid unspecified codes.

Diagnosis code selection

CPT (procedural) coding resources

These tips will help you select the most appropriate intervention codes.

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Interventions

Intervention CPT® codes are deliberately non-specific so that they can apply to various types of therapeutic scenarios. Therefore, in choosing an intervention code, the intent of the intervention should be a driving factor. What are you trying to achieve therapeutically? Review a complete list of commonly used occupational therapy CPT codes.

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Orthotics

CPT® codes for orthotic and prosthetic management and training can be used for orthotic evaluation, selection, fabrication, and training.

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Timed CPT codes

Understand different payer methodologies for billing time-based occupational therapy intervention codes.

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Modifiers

Learn when and how to use modifiers for successful reimbursement.

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NCCI edits

The Medicare National Correct Coding Initiative (NCCI; also known as CCI) was implemented to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Medicare Part B claims. NCCI Edits are updated quarterly to prevent improper payments when incorrect code combinations are reported.

NCCI Edits only apply to Medicare Part B services. State Medicaid agencies and other third-party and commercial payers are also required to use CCI Edits but may modify them to meet their own programmatic needs. Please check with non-Medicare payers regarding their use of CCI Edits.

NCCI edits