Occupational therapy CPT codes are five-digit numeric codes used by occupational therapists and billing specialists to report services to Medicare, Medicaid, and commercial insurance payers. The most frequently used occupational therapy CPT codes fall into five categories: evaluation codes (97165, 97166, 97167, 97168), therapeutic procedure codes (97110, 97112, 97530, 97535, 97537), cognitive intervention codes (97129, 97130), modality codes, and assistive technology codes (97755, 97760). Most treatment codes are timed and billed in 15-minute units using the CMS 8-Minute Rule from the Medicare Claims Processing Manual, Chapter 5.
Four changes to the 2026 CMS Physician Fee Schedule directly affect OT practice revenue. The efficiency adjustment reduces evaluation reimbursement permanently. Three new RTM codes create billing opportunities most practices haven't implemented yet. The KX modifier threshold increased to $2,480. Telehealth was extended through December 31, 2027. Every OT practice that hasn't updated its billing workflow for 2026 is leaving revenue it has already earned sitting on the table.
MedSole RCM's certified billing specialists manage occupational therapy revenue cycles for practices nationwide. Every rate, threshold, and billing rule in this guide is sourced directly from CMS and AOTA documentation. For practices that want a billing team handling all of this at 2.99% of collections, with credentialing starting at $99 per payer, our outsourced medical billing services page explains the complete service structure.