Outpatient Occupational Therapy Billing? - Where are the resources & what can my OT bill for?

Understanding Occupational Therapy Billing Codes: A Parent- and Therapist-Friendly Guide

Occupational Therapy (OT) covers a wide range of services—from sensory processing, equipment training, daily living skills, motor development, mobility support, and functional independence. For families, caregivers, and even new clinicians, understanding OT billing codes (CPT codes) can help explain what services are being provided and why they matter. Below is a clear, user-friendly guide to OT outpatient CPT codes, including parent-friendly descriptions. I used Chat GPT to write most of this and included links to the Colorado HCPF billing manual at the bottom. This is very informative but mainly to show you that there are so many options possible for occupational therapy that are LEGAL and OKAY to use and bill for in the state of Colorado. Don’t be limiting your practice, do what’s best for you patient, that is what I’ve always believed in.

1. Evaluation Codes (Used at Start of Services or Re-evaluations)

CPT Code

Description

97161 OT Evaluation – Low Complexity: Simple assessment with limited treatment planning.

97162 OT Evaluation – Moderate Complexity: Multiple factors, standardized assessments, more detailed planning.

97163 OT Evaluation – High Complexity: Complex conditions, extensive assessments, and customization.

97164 OT Re-evaluation: Updating the treatment plan due to changes in condition or needs.

2. Core OT Treatment Codes

CPT Code

Description

97010 Application of Hot or Cold Packs – Used to relieve pain, reduce inflammation, and prepare muscles for exercise.

97012 Traction (Mechanical) – Gentle stretching of joints or spine for pain relief or mobility improvement.

97014 Electrical Stimulation (Therapeutic) – Uses mild electrical currents to help muscle activation or reduce pain.

97016 Vasopneumatic Devices – Compression therapy to improve circulation and reduce swelling.

97018 Paraffin Bath – Warm wax therapy to relieve stiffness and improve hand mobility.

97022 Whirlpool (Therapeutic) – Water-based therapy to improve range of motion, strength, and circulation.

97024 Diathermy (Therapeutic) – Deep heating treatment for muscles and joints.

97026 Infrared (Therapeutic) – Light therapy to reduce pain and promote healing.

97028 Ultraviolet (Therapeutic) – Light treatment for skin conditions or healing support.

97032 Electrical Stimulation – Medium or high frequency for muscle strengthening or pain relief.

97033 Iontophoresis – Delivers medication through the skin using electrical current.

97034 Contrast Bath – Alternating hot and cold water immersion for pain relief and circulation.

97035 Ultrasound (Therapeutic) – Sound waves to reduce pain, improve tissue healing, and mobility.

97036 Electrogalvanic Stimulation – Gentle electrical stimulation for pain relief and circulation.

97110 Therapeutic Exercise – Strength, flexibility, and range of motion exercises (per 15 min).

97112 Neuromuscular Re-education – Balance, coordination, posture, body awareness, motor planning (per 15 min).

97113 Aquatic Therapy – Therapeutic exercises in water (per 15 min) using resistance, buoyancy, and temperature to improve strength, flexibility, and balance.

97116 Gait Training – Walking, wheelchair, transfers, movement safety training (per 15 min).

97124 Massage Therapy – Hands-on soft tissue techniques for relaxation, mobility, or pain relief.

97129 Cognitive Function Intervention – Initial 15 min (attention, memory, problem-solving).

97130 Cognitive Function Intervention – Each additional 15 min.

97140 Manual Therapy – Hands-on mobilization of muscles and joints (per 15 min).

97150 Group Therapeutic Procedures – Exercises or functional activities done in a group setting.

3. Sensory and Perceptual Integration Codes

CPT Code

Description

97533 Sensory Integration Techniques – Sensory processing, modulation, calming strategies (per 15 min).

4. Wheelchair, Mobility, and Assistive Technology

CPT Code

Description

97542 Wheelchair Management – Fitting, training, positioning, transfers (per 15 min).

97755 Assistive Technology Assessment – Evaluating needs for adaptive tools, seating, communication equipment, environmental access.

5. Orthotic and Prosthetic Management

CPT Code

Description

97760 Initial orthotic management and training – Splinting, brace fitting, donning/doffing education (per 15 min).

97761 Initial prosthetic training – Teaching use of prosthetic limbs, movement, care, function (per 15 min).

97763 Follow-up orthotic/prosthetic adjustments and training (per 15 min).

6. Performance Testing and Special Assessments

CPT Code

Description

97750 Physical Performance Testing – Standardized testing for strength, mobility, coordination, endurance with written report.

97546 Additional hour of work conditioning (when 97545 is already billed).

97799 Unlisted OT procedure – Used when no existing code applies (custom interventions, non-standard equipment).

7. Work Conditioning / Work Hardening (often for adults or transition-age youth)

CPT Code

Description

97545 Work conditioning – First two hours (return-to-work skills, physical stamina, cognitive demands).

97546 Each additional hour of work conditioning.

How to Use These Codes in Practice

• Use evaluation codes on initial intake or reassessment.

• Use therapeutic activity codes (97530) for hands-on, real-world practice like dressing, feeding, handwriting, and play.

• Use 97112 for motor planning, body awareness, balance, and self-regulation.

• Use 97113/97150 for aquatic therapy to provide low-impact strengthening and coordination.

• Use 97010–97036 for physical modalities to prepare, relax, or treat musculoskeletal issues.

• Use 97760/97761/97763 when working with splints, braces, prosthetics, ranging, and training.

• Use 97755 for assistive technology assessments such as specialized feeding equipment, positioning devices, or AAC mounting.

• 97799 is helpful for innovative, adaptive home and community-based OT interventions not otherwise covered.

Why This Matters for Families and Clinics

Understanding these codes:

• Helps families understand exactly what their child is working on.

• Supports clear documentation for reimbursement, IFSP/IEP, Medicaid, or insurance audits.

• Empowers clinic administrators to bill correctly, ethically, and comprehensively.

• Demonstrates that OT is not “just exercise”—it includes sensory regulation, equipment training, emotional, cognitive, and daily living skills.

Where can you find this information (for free and open to the public) - https://hcpf.colorado.gov/ptot-manual

Just a reminder that I wrote this with ChatGPT and added my own thoughts here and there. I hope this makes you feel informed about your family’s care. – Holly Ross OTR/L, WSI/T, LTP, ATRIC.