SpecialtiesTherapy & rehabilitation
How we see occupational therapy billing.
Reviewed by the VisMed therapy & rehabilitation billing team
Occupational therapy is billed in the same timed-unit system as physical therapy, under the same plan-of-care certification and progress-note requirements, with the same Medicare threshold and assistant modifiers. Everything that goes wrong in physical therapy billing goes wrong here.
The differences are in the population and the settings. A large share of occupational therapy is pediatric and paid by Medicaid, with state-specific authorization, visit limits and documentation rules. Services happen in homes, schools and clinics with different place-of-service and billing-provider requirements. Evaluation codes step by complexity, and payers challenge the higher levels.
VisMed brings the unit and compliance system we use for physical therapy, adds per-state Medicaid rules and setting-specific claim construction, and gives your therapists evaluation templates that capture the complexity elements the higher codes require.
Where occupational therapy practices lose money
The patterns we find in the aging and denial history before anything else changes.
Units and certification
Miscounted timed units, lapsed certifications and missed progress notes cost the same here as in physical therapy.Evaluation level unsupported
Evaluation codes step by complexity of history, performance deficits and decision-making. Notes that do not show the elements are downcoded.Medicaid authorization and limits
State plans and their managed-care organizations require authorization with specific forms and limit visits per period. Visits outside them are unpaid.Setting and provider errors
Home, school and clinic services carry different place-of-service codes and, in some states, different billing-provider rules. Errors are denials.Assistant modifiers
Services furnished by occupational therapy assistants need the modifier and carry a payment reduction for Medicare.
What we do differently for occupational therapy
Specialty-matched coders and a denials specialist, working inside your own system.
We run the same unit and compliance system as PT
Timed units from the record, a certification and progress-note calendar per patient, and authorization counts per episode.We hold Medicaid rules per state and plan
Authorization forms, visit limits and documentation requirements are held per plan and applied at intake.We build claims by setting
Place of service and billing provider are set by where the service happened and the payer’s rules.We give therapists evaluation templates
Documentation that captures the occupational profile, performance deficits and decision-making, so the evaluation level is supported.
What we bill
The procedure and code families your account team already works in.
Occupational therapy billing, asked and answered.
What a physician-owner in this specialty asks on the first call.
How does VisMed handle pediatric Medicaid authorizations?
Each state plan and managed-care organization has its own forms, criteria and visit limits, and VisMed holds them per plan. Requests go out with the documentation the plan expects, and we track visit counts so a new request precedes exhaustion.
Why are our evaluations being paid at the lowest level?
Because the note did not show the complexity elements: the occupational profile and history, the number of performance deficits, and the decision-making. VisMed’s templates prompt for them so the level billed is the level supported.
Can VisMed bill services delivered in schools and homes?
VisMed applies the place-of-service and billing-provider rules for each setting and payer, including state-specific school-based program rules where they apply.
Does VisMed handle orthosis fabrication billing?
VisMed bills fabrication codes and, where applicable, the orthosis itself as DME, with the documentation and supplier rules each requires.
Can VisMed bill early intervention programs?
Where your state’s early intervention program contracts with private providers, yes. VisMed sets up the program’s billing requirements, which differ from Medicaid and commercial plans, as a separate lane during onboarding.
Also in therapy & rehabilitation
Physical therapy
Timed units, KX modifiers and progress notes.
Speech therapy
Evaluation vs treatment, pediatric Medicaid.
ABA therapy
Adaptive-behavior codes, authorization units and BCBA supervision.
Chiropractic
AT modifiers, maintenance rules and Medicare limits.
Podiatry
Routine foot-care exceptions and DME.
All specialties
The full list, in six groups
See where your occupational therapy practice is losing money. Free.
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