Occupational Therapy Procedure Codes

Information is available for dates of service before July 1, 2017

Covered OT services are identified by the allowable CPT and HCPCS procedures codes listed in the following table.

Note: Procedure codes for many OT services are defined as 15 minutes. One unit of these codes = 15 minutes. If less than 15 minutes is used, bill in decimals. For example, 7.5 minutes = .5 units. All other procedure codes for OT services do not have a time increment indicated in their description. For these procedure codes, a quantity of "1" indicates a complete service.

Evaluations

Procedure Code

Description

97165^*

Occupational therapy evaluation, low complexity, requiring these components:

An occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem;

An assessment[s] that identifies 1—3 performance deficits [ie, relating to physical, cognitive, or psychosocial skills] that result in activity limitations and/or participation restrictions; and

Clinical decision making of low complexity, which includes an analysis of the occupational profile, analysis of data from problem-focused assessment[s], and consideration of a limited number of treatment options. Patient presents with no comorbidities that affect occupational performance. Modification of tasks or assistance [eg, physical or verbal] with assessment[s] is not necessary to enable completion of evaluation component.

Typically, 30 minutes are spent face to face with the patient and/or family.

97166^*

Occupational therapy evaluation, moderate complexity, requiring these components:

An occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current functional performance;

An assessment[s] that identifies 3—5 performance deficits [ie, relating to physical, cognitive, or psychosocial skills] that result in activity limitations and/or participation restrictions; and

Clinical decision making of moderate analytic complexity, which includes an analysis of the occupational profile, analysis of data from detailed assessment[s], and consideration of several treatment options. Patient may present with comorbidities that affect occupational performance. Minimal to moderate modification of tasks or assistance [eg, physical or verbal] with assessment[s] is necessary to enable patient to complete evaluation component.

Typically, 45 minutes are spent face to face with the patient and/or family.

97167^*

Occupational therapy evaluation, high complexity, requiring these components:

An occupational profile and medical and therapy history, which includes review of medical and/or therapy records and extensive review of physical, cognitive, or psychosocial history related to current functional performance;

An assessment[s] that identifies 5 or more performance deficits [ie, relating to physical, cognitive, or psychosocial skills] that result in activity limitations and/or participation restrictions; and

Clinical decision making of high analytic complexity, which includes an analysis of the patient profile, analysis of data from comprehensive assessment[s], and consideration of multiple treatment options. Patient presents with comorbidities that affect occupational performance. Significant modification of tasks or assistance [eg, physical or verbal] with assessment[s] is necessary to enable patient to complete evaluation component.

Typically, 60 minutes are spent face to face with the patient and/or family.

97168^*

Re-evaluation of occupational therapy established plan of care, requiring these components:

An assessment of changes in patient functional or medical status with revised plan of care;

An update to the initial occupational profile to reflect changes in condition or environment that affect future interventions and/or goals; and

A revised plan of care. A formal reevaluation is performed when there is a documented change in functional status or a significant change to the plan of care is required.

Typically, 30 minutes are spent face to face with the patient and/or family.

Therapeutic Procedures

Procedure Code

Description

97110

Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility

97112

neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities

97124

massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)

97139

Unlisted therapeutic procedure (specify)

97140^**

Manual therapy techniques (eg, mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes

97150

Therapeutic procedure(s), group (2 or more individuals)

97530

Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes

97532

Development of cognitive skills to improve attention, memory, problem solving, (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes

97533

Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes

97535

Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 minutes

97542

Wheelchair management (eg, assessment, fitting, training), each 15 minutes

97597^*

Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area less than or equal to 20 square centimeters

97598^*

Total wound(s) surface area greater than 20 square centimeters

97761

Prosthetic training, upper and/or lower extremity(s), each 15 minutes

Modalities

Procedure Code

Description

90901

Biofeedback training by any modality

97016

Application of modality to one or more areas; vasopneumatic devices

97018

paraffin bath

97022

whirlpool

97032

Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes

97033

iontophoresis, each 15 minutes

97034

contrast baths, each 15 minutes

97035

ultrasound, each 15 minutes

Evaluations
Procedure Code	Description
97165^*	Occupational therapy evaluation, low complexity, requiring these components: An occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem; An assessment[s] that identifies 1—3 performance deficits [ie, relating to physical, cognitive, or psychosocial skills] that result in activity limitations and/or participation restrictions; and Clinical decision making of low complexity, which includes an analysis of the occupational profile, analysis of data from problem-focused assessment[s], and consideration of a limited number of treatment options. Patient presents with no comorbidities that affect occupational performance. Modification of tasks or assistance [eg, physical or verbal] with assessment[s] is not necessary to enable completion of evaluation component. Typically, 30 minutes are spent face to face with the patient and/or family.
97166^*	Occupational therapy evaluation, moderate complexity, requiring these components: An occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment[s] that identifies 3—5 performance deficits [ie, relating to physical, cognitive, or psychosocial skills] that result in activity limitations and/or participation restrictions; and Clinical decision making of moderate analytic complexity, which includes an analysis of the occupational profile, analysis of data from detailed assessment[s], and consideration of several treatment options. Patient may present with comorbidities that affect occupational performance. Minimal to moderate modification of tasks or assistance [eg, physical or verbal] with assessment[s] is necessary to enable patient to complete evaluation component. Typically, 45 minutes are spent face to face with the patient and/or family.
97167^*	Occupational therapy evaluation, high complexity, requiring these components: An occupational profile and medical and therapy history, which includes review of medical and/or therapy records and extensive review of physical, cognitive, or psychosocial history related to current functional performance; An assessment[s] that identifies 5 or more performance deficits [ie, relating to physical, cognitive, or psychosocial skills] that result in activity limitations and/or participation restrictions; and Clinical decision making of high analytic complexity, which includes an analysis of the patient profile, analysis of data from comprehensive assessment[s], and consideration of multiple treatment options. Patient presents with comorbidities that affect occupational performance. Significant modification of tasks or assistance [eg, physical or verbal] with assessment[s] is necessary to enable patient to complete evaluation component. Typically, 60 minutes are spent face to face with the patient and/or family.
97168^*	Re-evaluation of occupational therapy established plan of care, requiring these components: An assessment of changes in patient functional or medical status with revised plan of care; An update to the initial occupational profile to reflect changes in condition or environment that affect future interventions and/or goals; and A revised plan of care. A formal reevaluation is performed when there is a documented change in functional status or a significant change to the plan of care is required. Typically, 30 minutes are spent face to face with the patient and/or family.

Therapeutic Procedures
Procedure Code	Description
97110	Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility
97112	neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities
97124	massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)
97139	Unlisted therapeutic procedure (specify)
97140^**	Manual therapy techniques (eg, mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes
97150	Therapeutic procedure(s), group (2 or more individuals)
97530	Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes
97532	Development of cognitive skills to improve attention, memory, problem solving, (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes
97533	Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes
97535	Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 minutes
97542	Wheelchair management (eg, assessment, fitting, training), each 15 minutes
97597^*	Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area less than or equal to 20 square centimeters
97598^*	Total wound(s) surface area greater than 20 square centimeters
97761	Prosthetic training, upper and/or lower extremity(s), each 15 minutes

Modalities
Procedure Code	Description
90901	Biofeedback training by any modality
97016	Application of modality to one or more areas; vasopneumatic devices
97018	paraffin bath
97022	whirlpool
97032	Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes
97033	iontophoresis, each 15 minutes
97034	contrast baths, each 15 minutes
97035	ultrasound, each 15 minutes

* Procedure may not be provided by an occupational therapist assistant.

**When provided by certified occupational therapy assistants, Medicaid reimbursement is not available for myofascial release/soft tissue mobilization for one or more regions or joint mobilization for one or more areas (peripheral or spinal).

A unit of time is attained when the mid-point is passed. Providers should refer to the CPT guidelines for direction on reporting units on time based and non-time based procedures.

The same modality may not be reimbursed as a PT service and an OT service on the same date of service for the same member.