OT Practice Toolbox

• Low complexity (97165): Low complexity evaluations typically take 30 minutes to complete and may identify one to three performance deficits. The evaluation should describe a brief medical history, the patient’s medical record, and the primary complaint requiring service.

• Moderate complexity (97166): Moderate complexity evaluations can take 45 minutes and typically identify three to five performance deficits. The evaluation should include a more detailed record of the patient’s therapy history, including more factors regarding functional performance.

• High complexity (97167): High complexity evaluations can take 60 minutes and may identify five or more performance deficits and multiple treatment options. You must include a detailed assessment and the patient’s therapy history record regarding their functional status.

• 97530: Therapeutic activity (one-on-one patient contact) to improve functional performance

• 97535: Self-care or home management training (compensatory strategies, meal prep, etc.)

• 97112: Neuromuscular re-education

• 97633: Sensory integrative techniques to promote adaptive responses

• 97110: Therapeutic procedures

• 97140: Manual therapy techniques

• 97113: Aquatic therapy

• 97150: Group therapy

Based on the Medicare benefit policy manual, insurance providers typically follow the 8-Minute Rule, where you must include a timed modifier of at least one unit for services provided for more than eight minutes. According to this Medicare Part B rule, services under eight minutes will not be billable.

After reaching the eight-minute threshold, the number of units you bill will progress in durations of 15 minutes:

• 1 unit: 8 to 23 minutes

• 2 units: 23 to 38 minutes

• 3 units: 38 to 53 minutes

• 4 units: 53 to 68 minutes

• 5 units: 68 to 83 minutes

• 6 units: 83 to 98 minutes

• 7 units: 98 to 112 minutes

• 8 units: 113 to 127 minutes