Top CPT Codes for Occupational Therapy Billing in 2025

In 2025, accurate CPT coding is more important than ever for occupational therapy (OT) practices across the US. With evolving healthcare regulations and increasingly stringent Medicare and private insurance requirements, staying compliant is critical for both revenue and patient care. Incorrect or outdated coding not only leads to denied claims but can also trigger audits and delay payments. For busy OT clinics already juggling patient care, the financial strain caused by billing errors can be overwhelming.

Understanding the latest CPT codes and using them correctly ensures you receive timely reimbursements while staying compliant. With audits becoming more frequent and therapy caps under closer scrutiny, OTs must adapt their billing practices to meet payer demands. In this guide, we’ll break down the top CPT codes for 2025, offer compliance and reimbursement tips, and share how practices can reduce their billing workload while improving revenue.

Why Accurate CPT Coding Matters for OT Practices in 2025

Accurate CPT coding is not just about getting paid; it’s about keeping your practice financially healthy and compliant with regulations. Over the past few years, CMS and private payers have tightened requirements for medical necessity and documentation. As a result, OT providers face:

Higher audit risks when coding errors or insufficient documentation are found.
Stricter rules for timed vs. untimed codes, particularly for Medicare.
Lost revenue opportunities due to denied or underpaid claims.

OT services are often individualized and complex, making it crucial to document and code each session accurately. The right CPT code communicates the service provided, its complexity, and its medical necessity. Missteps here can result in compliance issues and financial penalties.

READ HERE: Importance of Medical Billing and Coding in the Medical Industry

Top Occupational Therapy CPT Codes for 2025

To help you stay current, here are the most frequently used OT CPT codes for 2025, along with what they represent:

97165 – Low Complexity OT Evaluation

Used when evaluating a patient with minimal performance deficits and no comorbidities.

97166 – Moderate Complexity OT Evaluation

For patients with multiple performance deficits or some additional factors affecting treatment.

97167 – High Complexity OT Evaluation

Used when evaluating patients with significant deficits and multiple comorbidities requiring complex treatment planning.

97110 – Therapeutic Exercise

Covers exercises to improve strength, endurance, range of motion, or flexibility.

97112 – Neuromuscular Re-education

Used for re-educating movement and coordination due to neurological conditions.

97140 – Manual Therapy Techniques

Includes soft tissue mobilization, joint mobilization, and manual lymphatic drainage.

97530 – Therapeutic Activities

For dynamic activities designed to improve functional performance in real-life contexts.

97535 – Self-care/Home Management Training

Covers training patients in activities like meal preparation, safety procedures, or adaptive techniques.

Additional codes often used in OT include those for modalities such as electrical stimulation, ultrasound, or group therapy sessions. Many of these codes are timed, meaning reimbursement is based on the duration of service, while others (like evaluations) are untimed. Understanding the difference is key to avoiding underbilling or overbilling.

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OT Billing Best Practices for 2025

To stay compliant and maximize reimbursement, OT practices should follow these key billing strategies:

Understand the Medicare therapy threshold

Track patient progress and apply the KX modifier when services exceed the therapy cap, ensuring medical necessity is documented.

Document medical necessity thoroughly

Include objective measures and clear justifications for treatment frequency and duration.

Apply the 8-minute rule correctly

For timed codes, ensure units billed align with the actual minutes provided.

Avoid duplicate or missing codes

Double-check documentation before claim submission to prevent rejections or delays.

Stay updated on payer requirements

Private payers and Medicare may have different guidelines for modifiers, caps, or authorization requirements.

Billing mistakes are often the result of rushed documentation or a lack of training on new regulations. A consistent internal review process can help catch these errors before claims are submitted.

How MaxRemind Simplifies OT Billing and Improves Revenue

Managing billing in-house can be time-consuming and stressful. That’s why many OT practices are turning to specialized medical billing partners like MaxRemind. By outsourcing billing, providers can focus on patient care while ensuring their claims are accurate and compliant.

MaxRemind offers:

Expert CPT and ICD-10 coding support tailored for OT services.
Real-time claim submission and follow-ups to minimize delays.
Denial management and revenue recovery for underpaid or rejected claims.
Automated RCM tools and detailed financial reporting, giving you better insight into your practice’s revenue cycle.

With nationwide experience and deep knowledge of Medicare and private payer policies, MaxRemind helps OT practices streamline their billing processes, reduce errors, and improve cash flow.

Conclusion

Correct CPT coding is essential for occupational therapy clinics in 2025. With payer audits on the rise and evolving documentation rules, OTs must stay updated to avoid compliance issues and revenue loss. By using the right codes, following best practices, and leveraging expert billing support, you can protect your practice financially and deliver care without administrative burdens.

If you want to simplify OT billing and improve your revenue cycle, consider partnering with a team that specializes in OT billing, like MaxRemind. Let professionals handle the coding and claims so you can focus on providing patient care.

Ready To Improve Your OT billing Practice Revenue Cycle?

Contact MaxRemind today to learn how our OT billing solutions can optimize your practice’s financial performance.

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FAQs

What are the most commonly used CPT codes for occupational therapy in 2025?: The most frequently used OT CPT codes include 97165–97167 for evaluations of varying complexity, 97110 for therapeutic exercises, 97112 for neuromuscular re-education, 97140 for manual therapy, 97530 for therapeutic activities, and 97535 for self-care training. Using these correctly with proper documentation helps ensure accurate billing and timely reimbursements.
What is the difference between timed and untimed OT CPT codes?: Timed codes, like 97110 and 97140, are billed in 15-minute increments based on the actual one-on-one therapy time spent with the patient. Untimed codes, such as the evaluation codes 97165–97167, are billed once per session regardless of the duration, but documentation must still reflect the services provided.
How can OT practices avoid claim denials related to CPT coding?: To reduce denials, ensure documentation supports medical necessity, follow payer-specific billing rules, and use modifiers like KX or 59 correctly when required. Regular audits, proper code selection, and staff training on insurance policies also help prevent billing errors and delays.
What are the Medicare OT therapy thresholds for 2025?: Medicare maintains an annual therapy threshold for occupational therapy services, and once a practice exceeds this amount, the KX modifier must be added to justify continued medical necessity. Practices should monitor patient progress and maintain detailed records to stay compliant and avoid reimbursement issues.
How can outsourcing OT billing to a company like MaxRemind help my practice?: Outsourcing OT billing can save administrative time, reduce claim errors, and improve cash flow by leveraging expert coders who specialize in therapy billing. Services often include denial management, compliance monitoring, and payer follow-ups, which allow practices to focus more on patient care and less on billing complexities.