Coding & Billing

Want to know more about the roles and responsibilities of the AOTA Coding Advisory Team? Watch a video on understanding those roles and responsibilities and how you can get involved!

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New Evaluation Codes Recognize OT Clinical Decision Making; Now It’s Up to You!

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UPDATED: New CPT Code for Cognitive Intervention Takes Effect in 2018
A new CPT® code for cognitive function intervention (97127) takes effect January 1, 2018, replacing CPT code 97532. While private insurance and Medicaid may cover this code, The Centers for Medicare & Medicaid Services (CMS) has created a separate code for use in Medicare.

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New Occupational Therapy Evaluation and Re-Evaluation Codes (Effective January 1, 2017)

New occupational therapy CPT® evaluation and re-evaluation codes under the Physical Medicine and Rehabilitation section of the CPT® Manual have replaced existing CPT® codes 97003 and 97004. Get member educational resources associated with proper use of the new evaluation codes (more resources coming soon!).

VIEW CPT® EVALUATION CODES RESOURCES

ICD-10 Resources

The new ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) system, replaced the ICD-9-CM (9th Revision) on October 1, 2015. AOTA developed the following resources to help occupational therapists prepare for the implementation deadline.

VIEW ICD-10 CODING RESOURCES

• 2018 Selected Occupational Therapy CPT Codes - pdf 
• Medicare Correct Coding Initiative and Medically Unlikely Edits
• CMS Medicare Physician Fee Schedule Calculator

• Selected HCPCS Level II Codes - pdf 

• Medicare Part B Functional Reporting Requirements 
• Resources for G Code Functional Data Reporting 

• How to Reflect Practitioner Time in CPT® Codes
• Occupational Therapists Should Continue Modifier 59 Use
• CMS MLN Matters Article SE1418: Proper Use of Modifier 59
• Medicare Claim Review Programs: MR, NCCI Edits, MUEs, CERT, and RAC

For additional assistance with payment and reimbursement issues, contact AOTA’s Regulatory Affairs department at regulatory@aota.org.