Covered Codes for Occupational (OT) Therapy Providers –

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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