What insurers look for in an OT superbill
Occupational therapy is judged on function. Reviewers want to see that each billed service connects a diagnosis to a specific limitation in daily life, such as dressing, writing, returning to work or self-feeding, and that the codes match what the patient actually did during those minutes. A clear OT superbill lists each code separately with its units, adds the GO modifier, and points each line to the diagnosis it treats.
Beyond that, insurers expect the usual details: your OTR/L credentials and license number, an individual NPI, a Tax ID, the patient’s insurance carrier, member ID and group number, and a date, place of service and fee per unit on every line.
Occupational therapy codes at a glance
| Code | When to use it |
|---|---|
| 97165 / 97166 / 97167 | Initial evaluation, chosen by the depth of the occupational profile, the number of performance deficits and the complexity of decision making |
| 97168 | Re-evaluation when the patient’s status or plan of care changes |
| 97530 | Dynamic functional tasks: reaching, grasp and release, transfers, simulated work tasks |
| 97535 | Training in daily living: dressing, bathing, meal prep, home safety, adaptive equipment |
| 97110 | Exercise for strength, range of motion or endurance |
| 97112 | Retraining of balance, coordination, motor control or sensation |
| 97140 | Hands-on techniques such as joint or soft tissue mobilization and edema management |
| 97533 | Sensory integration techniques, most often in pediatric OT |
| 97129 + 97130 | Cognitive interventions: first 15 minutes, then each additional 15 |
| 97760 | Fitting and training for an orthosis at the first orthotic encounter |
| 97763 | Follow-up orthotic or prosthetic checks and training |
| 97150 | Group treatment, one unit per patient |
| 97018 | Paraffin bath, one unit per visit |
Evaluations, group treatment and paraffin are untimed. Everything else in the table is billed in 15-minute units of one-on-one time.
How timed OT units add up
Medicare totals the minutes of all timed services in a visit and converts the total into units: 8 to 22 minutes is one unit, 23 to 37 is two, 38 to 52 is three, and so on. Commercial plans and Medicaid programs do not all follow that method; some count each code on its own and give a unit once that code reaches 8 minutes.
The two methods can produce different superbills. Suppose a session includes 25 minutes of therapeutic activities and 12 minutes of ADL training, 37 timed minutes in all. Under Medicare’s total-time method that is two units: one 97530 and one 97535. Under a per-code method, 25 minutes of 97530 is two units and 12 minutes of 97535 is one, for three. Find out which method the patient’s plan uses, and record total timed minutes in your note so the units can be checked.
Orthotics, splints and hand therapy
Hand therapists often fabricate or fit splints. Your time fitting the orthosis and training the patient to use it goes on 97760 at the first orthotic encounter and 97763 at later check-ins. The device itself is normally billed with a separate HCPCS supply code, and plans differ on whether they cover it and which code they accept. If you list a device on the superbill, use the code the plan accepts and describe it plainly.
For rehab after a fracture, use the subsequent-encounter version of the injury code, ending in D for routine healing, as the sample does. The “A” version is for active treatment of the injury itself.
Modifiers and place of service
GO marks a service as part of an occupational therapy plan of care. Medicare requires it on every line, and many commercial plans expect it. KX and CO are Medicare modifiers: KX shows medically necessary therapy above the yearly threshold, and CO flags care provided in whole or in part by an OT assistant. Use 59 or XS only when a payer would otherwise bundle two truly separate services. Some plans also ask you to label services as habilitative (modifier 96) or rehabilitative (modifier 97). Clinic visits use POS 11, home visits POS 12, and school-based services POS 03. For telehealth, follow the plan’s instructions.
OT-specific gotchas
- Pediatric and developmental care. Some plans exclude developmental or sensory therapy, while others cover it under habilitative benefits. Coverage varies by plan.
- Referrals and plans of care. Many plans require a physician referral or a certified plan of care before they reimburse OT, even out of network.
- Visit limits. Some plans apply one combined yearly visit limit to PT, OT and speech therapy.
- Medicare. Occupational therapists cannot opt out of Medicare, so check Medicare’s rules before taking cash from a Medicare beneficiary for covered therapy.
How to fill this occupational therapy superbill template
- Practice and therapist. Enter the practice name, your name, credentials (OTR/L or OTD), license number, address, phone, email, NPI and Tax ID. The NPI field checks the check digit.
- Patient. Add name, date of birth, address, insurance carrier, member ID and group number. For a child, use the child’s details with the policy information from the parent’s card.
- Diagnoses. Enter the medical diagnosis first, then functional or treatment diagnoses, up to 12 lettered A to L.
- Service lines. For each visit, add one line per code with the date, GO modifier, POS, diagnosis pointer, units and per-unit fee.
- Finish. Enter the amount paid, type your signature, clear anything the checklist flags, and Print / Save as PDF.
Make your OT superbill
Load the sample to see a completed hand therapy superbill, then add your own details in the generator above; nothing is uploaded. Review what to include on a superbill and our annotated superbill example, and share how to submit a superbill to insurance with patients. Rehab clinics can also use the physical therapy and speech-language pathology templates.