Covered Codes for Occupational (OT) Therapy Providers -

Covered Codes for Occupational (OT) Therapy Providers

Covered Codes for Occupational Therapists (OT) - Use modifier “GO” when billing these codes.

Code	Description	Session Limit	Other Instructions
97003	Occupational therapy evaluation	1 unit	Limited to 1 evaluation per provider, per condition, per calendar year.
97004	Occupational therapy re-evaluation	1 unit	Limited to once every 3 months.
97010	Application of a modality to one or more areas; hot or cold packs	1 unit	Covered codes in the range of 97010-97124 are limited to 4 modalities and/or therapeutic procedures in one day.
97014	Application of a modality to one or more areas; electrical stimulation (unattended)	1 unit	See “Other Instructions” for code 97010.
97016	Application of a modality to one or more areas; vasopneumatic devices	1 unit	See “Other Instructions” for code 97010.
97018	Application of a modality to one or more areas; paraffin bath	1 unit	See “Other Instructions” for code 97010.
97022	Application of a modality to one or more areas; whirlpool	1 unit	See “Other Instructions” for code 97010.
97032	Application of a modality to one or more areas; electrical stimulation (manual), each 15 min.	1 unit	See “Other Instructions” for code 97010.
97033	Application of a modality to one or more areas; iontophoresis, each 15 min.	1 unit	See “Other Instructions” for code 97010.
97034	Application of a modality to one or more areas; contrast baths, each 15 min.	1 unit	See “Other Instructions” for code 97010.
97035	Application of a modality to one or more areas; ultrasound, each 15 min	1 unit	See “Other Instructions” for code 97010.
97036	Application of a modality to one or more areas; Hubbard tank, each 15 min.	1 unit	See “Other Instructions” for code 97010.
97110	Therapeutic procedure, one or more areas, each 15 min.; therapeutic exercises	1 unit	See “Other Instructions” for code 97010. Prior authorization is required when used with code 97140. See “Other Instructions” for code 97140.
97112	Therapeutic procedure, one or more areas, each 15 min.; neuromuscular reeducation	1 unit	See “Other Instructions” for code 97010.
97124	Therapeutic procedure, one or more areas, each 15 min.; massage, including effleurage, pertrissage and/or tapotement	1 unit	See “Other Instructions” for code 97010.
97140	Manual therapy techniques (e.g., mobilization/ manipulation, manual lymphatic drainage, manual traction) one or more regions, each 15 min.	6 units of code 97140 OR 6 combined units of codes 97140, 97110 and/or 97535	Prior authorization is always required. One prior authorization is issued for ICD-9 codes 457.0, 457.1 and 757.0 for use with a combination of codes 97140, 97110 and/or 97535 for a maximum of 15 sessions (6 units per session) for a total of 90 units to be completed in approximately 3 weeks
97150	Therapeutic procedure(s), group (A group is 2 or more individuals.)	1 unit	Bill 1 unit for each recipient in the group.
97530	Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 min.	4 units
97532	Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact by the provider, each 15 min.	4 units
97533	Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) contact by the provider, each 15 min.	4 units
97535	Self-care/home management training (e.g., ADLs) direct (one-on-one) contact by provider, each 15 min.	4 units	Prior authorization is required when used with code 97140. See “Other Instructions” for code 97140.
97542	Wheelchair management/ propulsion training, each 15 min.	4 units
97760	Orthotic(s) fitting and training, upper extremity(ies), lower extremity(ies), and/or trunk, each 15 min.	4 units
97761	Prosthetic training, upper and/or lower extremities, each 15 min	4 units
97762	Checkout for orthotic/prosthetic use, established patient, each 15 min.	4 units