Occupational Therapy Billing Services for Rehab and Pediatric Clinics
OT evaluations, GO and CO modifiers, splint codes, and plan-of-care dates all affect payment. Our occupational therapy billing services keep claims accurate and compliant. OT clinics have worked with Pyramids Global since 2013.
Occupational Therapy Billing Services Designed for Functional Care
Our occupational therapy billing services focus on the details that decide OT payments. A single visit may combine ADL training, therapeutic activities, and a custom splint, and each piece needs the right CPT or HCPCS code, the GO modifier, and support in a signed plan of care. Pyramids Global assigns certified coders who review OT claims every day, so evaluations, timed procedures, orthotics, and assistant visits are coded carefully before they reach the payer. The aim is cleaner claims and steadier cash flow.
Why Occupational Therapy Billing Calls for Specialized Expertise
A child working on fine motor skills, an adult relearning daily tasks after a stroke, and a hand therapy patient recovering from tendon repair can share one schedule. Yet payers review each case differently. Medicare tracks a separate yearly threshold for OT and expects progress reports every 10 treatment days, while pediatric Medicaid and many commercial plans require prior authorization. That’s why our team checks benefits, remaining visits, and authorization needs before the first appointment. Our occupational therapy billing services then apply the right rules from day one, helping visits stay covered and claims move without delay.
Where Occupational Therapy Revenue Gets Lost - and How We Help Recover It
Most OT practices do not lose revenue through one large denial. Instead, small coding and documentation gaps repeat across many visits. These are four issues our occupational therapy billing services address most often:
How Our Occupational Therapy Billing Services Support Your Practice
Our occupational therapy billing services follow the same path as your patient’s care. From eligibility checks to final payment, each claim moves through defined steps with clear accountability.
Why Occupational Therapy Practices Work With Us
More than 500 healthcare practices across the United States rely on Pyramids Global for revenue cycle support. Here’s what OT clinics gain with our occupational therapy billing services.
Our Standards for Every Occupational Therapy Claim
Every OT visit you bill supports real progress, whether it is a child learning to hold a pencil or an adult returning to cooking and dressing after a stroke. That is why each occupational therapy claim receives the same careful review of units, modifiers, and plan-of-care dates before submission. A single coding error can repeat across many visits and affect weeks of payments if it goes unnoticed.
Our occupational therapy billing services are guided by three priorities. First, helping your clinic collect what it has earned for each OT visit. Second, keeping avoidable errors low through certified coders and real-time claim scrubbing. Third, giving you clear visibility into payments, denials, and appeals.
Additional Support for Occupational Therapy Clinics
Clean OT claims depend on the work done before and after billing, especially as practice guidance from the American Occupational Therapy Association continues to evolve. Alongside our occupational therapy billing services, Pyramids Global offers:
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- Medical coding services by certified coders using current CPT, ICD-10, and HCPCS Level II codes
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- Prior authorization services for OT evaluations, pediatric therapy plans, and custom orthotics, with requests typically started within 30 minutes of the order
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- Credentialing and provider enrollment for occupational therapists with Medicare, Medicaid, and commercial plans in 21 states
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- Premium Practice Audit to identify denial patterns and underbilled OT services
Occupational Therapy Billing Services – Common Questions From OT Clinics
What do Pyramids Global’s occupational therapy billing services cost?
Pricing is based on your claim volume, payer mix, and the services you need, with no setup fees. Book a free consultation and our team will share a clear quote for your practice.
Which occupational therapy services do you bill?
We bill OT evaluations and re-evaluations (97165 to 97168), self-care and ADL training, therapeutic activities, cognitive interventions, sensory integration, and orthotic management. We also bill custom splints, wheelchair training, and telehealth visits where covered.
How does the Medicare therapy threshold apply to OT claims?
Medicare sets a yearly threshold for occupational therapy that is separate from the combined physical and speech therapy amount. Above it, claims need the KX modifier and documentation showing care remains medically necessary.
Do you handle prior authorizations for occupational therapy?
Yes. We typically initiate prior authorization requests within 30 minutes of receiving the order. Payer decisions often take 24 to 72 hours for expedited requests and 7 to 14 business days for standard ones.
Can your team work in our current EHR?
Yes. Our billing team works inside your existing EHR or practice management system, so your therapists keep their usual workflow. We follow HIPAA-compliant processes and sign a Business Associate Agreement with every client practice.
When might our OT clinic see results?
Many clinics begin to see measurable improvement within 60 to 90 days, depending on payer mix, claim volume, and the condition of existing A/R.
Partner With a Team That Understands Occupational Therapy Billing
If denials are building up or payments are arriving late, our occupational therapy billing services can help you find and address the cause. Over 500 practices across the United States have strengthened their revenue cycle with Pyramids Global since 2013. Your OT clinic can start with a free billing review.
Hand off evaluation coding, GO, KX, and CO modifier tracking, prior authorizations, denial management, and A/R follow-up to a team that works on OT claims every day. Meanwhile, your therapists can stay focused on helping patients regain independence in daily life at home, at school, and at work.