Evaluations Coded Below Their Complexity
A complex occupational profile with multiple performance deficits billed as 97165 instead of 97167 loses money on the first visit, and the pattern repeats with every new patient.
Occupational Therapy Billing Services in Nevada for OT Clinics and Therapists
Occupational therapy billing services are the coding, timed-unit calculation, authorization tracking and payment recovery work that turn every evaluation, ADL session and custom splint into paid revenue. Nevada Medical Billing provides them for outpatient OT clinics, hand therapy practices, pediatric OT and multidisciplinary rehab groups in Las Vegas, Henderson, Reno and statewide, with a 98% first-pass clean claim rate.
You help people get back to the work of living. We make sure every skilled minute you deliver gets paid.
- OT billing and coding specialists (CPC, CPC-P)
- HIPAA compliant with a signed BAA
- Medicare, Nevada Medicaid, commercial and workers' comp
- Works inside WebPT, Prompt, Raintree, TheraOffice and Fusion
We review 90 days of OT claims, authorizations and remittances and show you where your revenue is slipping. No contract. No obligation.
Where OT Clinics Lose
Revenue Every Week
Occupational therapy runs on skilled minutes. When the minutes, modifiers or authorizations do not line up, payers hold back money you already earned. These seven leaks appear in almost every OT billing audit we run.
Timed Minutes Converted the Wrong Way
Medicare totals timed minutes across codes under the 8-minute rule, while many commercial plans need at least 8 minutes per code. Use one method for every payer and units go missing.
Missing GO, CO and KX Modifiers
A claim without GO denies. An OTA's service without CO invites recoupment. A visit above the OT threshold without KX denies automatically.
Plans of Care That Lapse
Medicare pays only with a certified plan of care, recertified at least every 90 days, with progress reports every 10 visits. A missed signature quietly voids weeks of visits.
Authorizations That Run Out Mid-Episode
Nevada Medicaid and many commercial plans authorize a set number of visits or units. When visits exceed the authorization, or the codes billed do not match it, the claims deny.
Custom Splints Billed Without the Device
The fitting is billed as 97760, but the custom orthosis needs its own L-code, and sometimes DMEPOS enrollment. Many clinics bill the time and give away the device.
Shared Visit Limits Nobody Is Tracking
Commercial plans often share one annual visit limit across PT, OT and speech. When disciplines do not see each other's counts, late-year visits deny.
Find out how many units, splints and visits your claims are missing. Request your free OT billing audit.
How Occupational
Therapy Billing Works
OT claims combine untimed evaluations with timed treatment codes, each tagged with modifiers that tell the payer who provided the care and whether thresholds have been passed.
Evaluations (untimed): 97165, 97166 or 97167, chosen by the complexity of the occupational profile, the performance deficits and clinical decision making. Re-evaluations use 97168.
Treatment (timed, 15-minute units): self-care and ADL training (97535), therapeutic activities (97530), therapeutic exercise (97110), neuromuscular re-education (97112), cognitive intervention (97129, 97130) and more.
Modifiers: GO on every OT line, CO when an OTA furnishes more than 10% of a service, KX above the annual OT threshold, and 59 or XU only for truly distinct services.
Plan of care: certified by a physician or NPP and recertified at least every 90 days for Medicare.
97535 · 33 minutes
97530 · 20 minutes
53 minutes
4 units · GO
A Medicare patient receives 33 minutes of ADL training (97535) and 20 minutes of therapeutic activities (97530). That is 53 timed minutes, which equals 4 units under the 8-minute rule: two units of 97535 and two of 97530, each with GO. Bill 3 units, or skip GO, and the visit pays less or not at all.
Full-Cycle OT
Billing Services
Nevada Medical Billing runs the whole OT revenue cycle or the stages your clinic wants to hand off. Your therapists keep treating; we keep the money moving.
- 01
Eligibility, Benefits and Visit Limits
We verify coverage, copays, deductibles and visit limits before the first visit, including limits shared across PT, OT and speech.
- 02
Prior Authorization Management
We request, track and renew authorizations for Nevada Medicaid and commercial plans, and alert your team before visits or units run out.
- 03
Plan-of-Care and Progress-Report Tracking
We track certification, recertification and 10-visit progress report dates for every Medicare patient, so no visit goes unpaid for a missing signature.
- 04
OT Coding and Charge Review
Our coders match evaluation complexity to documentation, convert minutes by payer rule and apply GO, CO and KX correctly before the claim leaves.
- 05
Claim Scrubbing and Submission
Claims go out within 24 to 48 hours of the signed note, after NCCI edits, MUE limits and payer-specific rules are checked.
- 06
Payment Posting and Underpayment Audits
We post every remittance line and compare it with the Medicare fee schedule, including MPPR, and your contracted rates.
- 07
Denial Management and Appeals
Denials are traced to their root cause (authorization, modifiers, plan of care or medical necessity) and appealed with the therapy note.
- 08
Patient Billing
Clear statements, online payment and payment plans for copays and deductibles that add up over a long plan of care.
- 09
Credentialing for OTs and OTAs
We enroll OTs with Medicare through PECOS, Nevada Medicaid and commercial plans through CAQH, and keep licenses and revalidation dates current.
OT Billing and Coding Built
for Occupational Therapy
OT is not PT with a different modifier. Our coders know the evaluation logic, the ADL codes and the documentation that proves skilled care.
OT Code Reference
| Code | Service | Billing note |
|---|---|---|
| 97165 / 97166 / 97167 | OT evaluation, low / moderate / high complexity | Untimed; complexity must match the documented profile and deficits |
| 97168 | OT re-evaluation | Needs a new finding, a significant change or a failure to progress |
| 97535 | Self-care and home management (ADLs) | Timed; document the task, cues and level of independence |
| 97530 | Therapeutic activities | Timed; functional, dynamic activities |
| 97129 / 97130 | Cognitive function intervention | First 15 minutes, then each additional 15 |
| 97533 | Sensory integrative techniques | Timed; common in pediatric OT |
| 97542 | Wheelchair management and training | Timed |
| 97150 | Group therapy | Untimed, billed per patient |
| 97760 / 97763 | Orthotic management and training | Initial and subsequent encounters |
Modifier Logic
GO on every OT line. CO when an OTA provides more than 10% of a service, paid at 85% by Medicare. KX once the patient passes the annual OT threshold. 59 or XU only when services are distinct and NCCI allows it.
Medicare Compliance
for OT Practices
Medicare rewards clinics that document well and punishes those that miss a deadline. We build every Medicare rule into your workflow.
2026 KX threshold: $2,480 for occupational therapy, tracked separately from the combined PT and speech amount. Claims above it need KX and supporting documentation.
Targeted medical review: claims can be reviewed once a patient's OT services pass $3,000.
MPPR: Medicare reduces practice expense by 50% on the second and later "always therapy" units on the same day. We post and reconcile it correctly, so it is never mistaken for an underpayment.
OTA supervision: Medicare allows general supervision of OTAs in private practice, but Nevada law and some plans can be stricter. We bill to the stricter rule.
Functional reporting: G-code reporting ended in 2019. We keep goals and progress documented without filling claims with obsolete codes.
Hand Therapy and Custom
Orthosis Billing
Hand and upper extremity therapy brings custom splints into the claim. We bill the fitting and training as 97760, follow-up visits as 97763, and the custom-fabricated orthosis on the correct HCPCS L-code, with DMEPOS enrollment and payer routing checked first. Certified Hand Therapist credentials are documented for plans that limit hand therapy to CHTs.
Pediatric OT and Nevada
Medicaid Billing
Pediatric OT for sensory processing, fine motor and developmental delays is largely funded by Nevada Medicaid and its managed care plans. Children under 21 are covered for medically necessary therapy through EPSDT.
Nevada Medicaid Provider Type 34 Rules
Nevada Medicaid bills therapy under Provider Type 34 and Medicaid Services Manual Chapter 1700. Every therapy service except evaluations and re-evaluations needs prior authorization on form FA-7, the claim must match the approved authorization, GO and CO are required, and the ordering provider's NPI must be enrolled with Nevada Medicaid. We manage each requirement before the visit, not after the denial.
Managed Care and School-Based Services
We bill Nevada Medicaid managed care plans under their own authorization rules, and keep clinic services separate from school health services, which are billed under a different provider type.
Workers' Comp and Auto Injury OT Billing
Nevada workers' comp pays OT under the Nevada Medical Fee Schedule, which sets a maximum allowable fee for licensed occupational therapists and updates every February 1. We send progress reports to adjusters, track authorized visits and pursue auto and personal injury claims to settlement.
PT, OT and SLP Billing for Multidisciplinary Rehab Clinics
Running physical therapy, occupational therapy and speech-language pathology under one roof multiplies the rules. We bill all three disciplines with the right modifier (GP, GO or GN), separate plans of care, the correct Medicare threshold (PT and speech share one amount; OT has its own) and visit limits that commercial plans share across disciplines.
- Physical therapyGP
- Occupational therapyGO
- Speech-language pathologyGN
OT Billing for Every
Practice Type
Outpatient OT Clinics
Private practice clinics billing Medicare, Medicaid, commercial and workers' comp.
Hand Therapy Practices
CHT-led clinics with high splint and orthotic volume.
Pediatric OT Practices
Sensory, fine motor and feeding programs funded largely by Medicaid and EPSDT.
Multidisciplinary Rehab Groups
Combined PT, OT and SLP practices with shared front desks and shared visit limits.
Mobile and Home-Based Outpatient OT
OT delivered in the patient's home under Part B, with place-of-service and travel rules applied.
Insurance Payers We Bill
for Nevada OT Practices
We bill Medicare Part B through Noridian (Jurisdiction F), Medicare Advantage plans, Nevada Medicaid fee-for-service and managed care plans, and commercial payers including Anthem Blue Cross Blue Shield, UnitedHealthcare and Health Plan of Nevada, Aetna, Cigna, Humana, Hometown Health and Prominence Health Plan. We also bill Nevada workers' comp insurers and TPAs, auto carriers, TRICARE West and VA Community Care.
Occupational Therapy Billing
Services Across Nevada
Las Vegas and Clark County
Las Vegas, Henderson, North Las Vegas, Summerlin, Spring Valley and Enterprise OT clinics serving high volumes of Medicaid children, Medicare seniors and workers' comp patients.
Reno, Sparks and Northern Nevada
Reno, Sparks, Carson City, Minden and Fallon clinics working with regional plans and a growing Medicare Advantage population.
Rural Nevada
Elko, Winnemucca, Ely and Pahrump therapists, billed remotely with the same OT expertise.
OT clinic anywhere in Nevada? Talk to an OT billing specialist at (631) 652-3106.
Call (631) 652-3106Technology and EMR
Integration
Therapy EMR Systems
WebPT, Prompt Health, Raintree, TheraOffice, Fusion Web Clinic and other therapy platforms, with secure, role-based access and no change to how your therapists document.
Clearinghouse Connectivity
Waystar, Availity, Trizetto and payer portals for 837P claims, eligibility checks and 835 remittance posting.
OT Revenue Dashboards
Collections per visit, units per visit, evaluation mix, authorization expirations, KX-threshold patients, denial rate by payer and days in A/R, updated daily and reviewed with you each month.
How Our OT Billing
Process Works
Free OT billing audit
We review 90 days of claims, authorizations and remittances, and quantify the revenue you are missing.
Custom plan and BAA
You choose full-cycle billing or targeted services. We sign the BAA and set up role-based access.
Payer and rules setup
We load your fee schedules, contracts, authorization rules, unit-conversion rules and threshold tracking.
Parallel launch
Our team works alongside your current billers for two weeks, so no visit falls through the handoff.
Backlog recovery
Unbilled visits, aged A/R, expired-authorization denials and underpayments are worked by dollar value and filing deadline.
Ongoing performance reviews
Monthly KPI reviews, documentation feedback and annual updates for every CPT and Medicare change.
OT Billing Results
You Can Measure
What Nevada OT clinics see in the first 90 days: In days 1 to 30, authorization and plan-of-care tracking go live and unbilled visits are cleared. In days 31 to 60, unit corrections, appeals and splint recoveries start returning cash. By day 90, authorization denials are falling and collections per visit are rising.
Outsourced OT Billing
vs an In-House Biller
| Factor | In-house biller | Nevada Medical Billing |
|---|---|---|
| OT-specific coding knowledge | Varies with each hire | Coders trained on OT evaluations, ADL codes and orthoses |
| Authorization and plan-of-care tracking | Spreadsheets and memory | Automated alerts before anything lapses |
| Thresholds and modifiers | Applied after denials | GO, CO and KX checked on every claim |
| Coverage during vacations and turnover | Billing stops | A trained backup team |
| Cost structure | Salary, benefits, software and training | One fee tied to collections |
See what outsourcing would change for your clinic. Book your free OT billing audit.
Flexible Pricing for OT
Billing Services
You pay for results. We price each engagement around visit volume, payer mix and services needed, and quote after reviewing your actual claims.
Percentage of Collections
The most common model for therapy practices. Our fee is a share of net collections, so we grow only when your clinic does. Across the industry, outsourced therapy billing typically runs between 4% and 8% of net collections.
Per-Visit Pricing
A fixed fee per billed visit suits high-volume clinics with a stable payer mix.
Targeted Services
Keep billing in-house and outsource only authorizations, credentialing, A/R cleanup or denial management.
HIPAA compliant · No obligation
Occupational Therapy
Billing FAQs
Can't find what you need? Our Nevada team answers every question before you commit.
Occupational therapy billing services manage the revenue cycle for OT practices: eligibility and authorizations, evaluation and treatment coding, GO, CO and KX modifiers, claim submission, payment posting, denial management and patient billing.
97165 for low complexity, 97166 for moderate complexity and 97167 for high complexity. A re-evaluation is billed as 97168 when there is a new finding, a significant change or a failure to progress.
$2,480. OT has its own threshold, separate from the combined amount for physical therapy and speech-language pathology. Claims above it need the KX modifier and supporting documentation.
When an occupational therapy assistant furnishes more than 10% of a service. Medicare pays those lines at 85% of the fee schedule, and Nevada Medicaid also requires CO for OTA services.
For Medicare, total timed minutes are added up across codes and converted to 15-minute units. Many commercial plans instead require at least 8 minutes for each code billed.
Yes. Apart from evaluations and re-evaluations, OT services billed under Provider Type 34 need prior authorization, and the claim must match the approved authorization.
The orthosis is billed on an HCPCS L-code, and the fitting and training as 97760. Some payers require DMEPOS supplier enrollment to bill the device.
Yes. We bill all three disciplines with the right modifiers, plans of care, thresholds and shared visit limits.
Most clinics pay a percentage of net collections, typically 4% to 8% across the industry. We quote after the free audit, based on your visit volume and payer mix.
Most clinics go live in about 30 days, including EMR access, payer setup and a two-week parallel launch.
Reviewed by the Nevada Medical Billing Therapy Billing Team (CPC certified coders specializing in PT, OT and SLP). Last updated October 2026.
Get Your Free OT
Billing Audit
Your therapists give patients back the ability to dress, cook, write and work. Let us give your clinic back the revenue it has already earned. In 30 minutes, we will show you the units, authorizations and splints missing from your claims and the underpayments still worth recovering.
HIPAA compliant · No obligation · Response within one business day · Prefer to talk? Call (631) 652-3106