Private occupational therapy practices
We manage the full revenue cycle for OTs in private practice, from credentialing and eligibility checks to claims, payments and patient balances.
Occupational therapy billing & RCM · California
Occupational Therapy Billing Services in California
California Billing Services provides occupational therapy billing services for private OT practices, pediatric clinics, hand therapy centers and multidisciplinary rehab practices across California. Evaluations and timed units are coded against the note, GO, CO and KX modifiers are applied where they belong, and plans of care and authorizations are tracked so visits do not outrun an approval.
Talk with our team about recent OT claims to see where revenue may be slipping away. Please do not send patient information through the inquiry form.
HIPAA-conscious workflowsTherapy billing and the 8-minute ruleMedicare, Medi-Cal, regional center and workers' comp payersBilling from your therapy EMR
0-min
Medicare rule applied to total timed minutes
$0,0
2026 Medicare OT threshold, tracked on its own
0%
Medicare payment on CO-modifier OTA lines
0
Workers' comp PT, OT and chiro visits per injury
How it works
How billing for occupational therapy services works
Occupational therapy is billed with an untimed evaluation code and timed treatment codes reported in 15-minute units. How those minutes turn into units depends on the payer. Medicare adds up all timed minutes for the visit and applies the 8-minute rule to the total, while many commercial plans count minutes for each code separately.
Here's why that matters. An OT spends 10 minutes on self-care training (97535), 10 minutes on therapeutic activities (97530) and 10 minutes on neuromuscular re-education (97112). Medicare totals the 30 minutes and pays 2 units. A commercial plan that counts each code separately may pay 3. Bill the commercial rule to Medicare and you've overbilled; bill the Medicare rule to a commercial plan and you've left a unit unpaid.
Same visit, two unit rules
- 97535 self-care training
- 10 min
- 97530 therapeutic activities
- 10 min
- 97112 neuromuscular re-ed
- 10 min
- Medicare (total minutes)
- 2 units
- Per-code commercial plan
- Up to 3 units
Who we serve
OT billing for every kind of California therapy practice
California Billing Services sets up billing around how your occupational therapy practice actually delivers care.
Pediatric OT clinics
We bill sensory integration, fine motor and developmental therapy to Medi-Cal plans, commercial insurers, California Children's Services and regional centers, and we track the authorizations and visit limits each one sets.
Hand therapy clinics
We bill hand and upper extremity therapy, custom splints and orthoses, and orthotic fitting and training, and we handle the separate device rules many payers apply to L-codes.
Multidisciplinary rehab practices
For practices offering OT alongside physical and speech therapy, we track each discipline's modifier, Medicare threshold and shared commercial visit limits so one service never uses up another's benefit.
Home health and mobile OT providers
We bill outpatient OT delivered in patients' homes and community settings, with the place-of-service and documentation details payers require for care outside the clinic.
Where revenue leaks
Where occupational therapy practices lose revenue
Most OT revenue isn't lost to big denials. It slips away one unit, one modifier and one expired approval at a time. These are the problems we find most often.
Units calculated with the wrong rule
Medicare's total-minutes method applied to commercial plans, or the reverse.
Missing or misused modifiers
GO left off Medicare claims, CO missing on assistant services, or KX added before the threshold is reached.
OT and PT thresholds confused
Treating OT as part of the combined PT and speech threshold, when Medicare tracks OT on its own.
Expired plans of care
Visits billed after the plan of care lapsed or before it was certified.
Authorizations that run out
Approved visits used up before a renewal is requested.
Bundled codes
Therapeutic activities billed with an evaluation without the documentation or modifier needed to pay both.
Unbilled splints and orthoses
Devices fabricated and fitted but never billed, or billed to the wrong contractor.
Medical coding
Occupational therapy billing and coding services
California Billing Services codes from the therapist's daily note and plan of care, not from a superbill alone. Every unit billed is backed by documented minutes and skilled intervention.
OT evaluations and re-evaluations
We bill evaluations at the complexity the documentation supports: 97165 for low, 97166 for moderate and 97167 for high complexity. Re-evaluations (97168) are billed only when there's a new clinical finding, a significant change in condition or a failure to progress.
Timed treatment codes
We bill self-care and home management training (97535), therapeutic activities (97530), therapeutic exercise (97110), neuromuscular re-education (97112), manual therapy (97140), cognitive function intervention (97129 and 97130), sensory integration (97533) and wheelchair management (97542), with units calculated under each payer's rule.
Therapy modifiers
Every OT line billed to Medicare carries the GO modifier. We add CO when an occupational therapy assistant furnished more than 10% of a service, which Medicare pays at 85% of the fee schedule, and KX once a patient passes the 2026 OT threshold of $2,480. We apply 59 or XU only when the documentation supports separate payment.
Hand therapy, splints and orthoses
We bill custom-fabricated splints and orthoses with the correct HCPCS L-code, orthotic fitting and training with 97760, and follow-up adjustments with 97763. We also confirm whether each payer requires DMEPOS supplier enrollment before the device is billed.
Group therapy, swallowing and remote monitoring
We bill group therapy (97150) per patient, swallowing treatment (92526) for OTs with California advanced practice approval, and remote therapeutic monitoring (98975-98981) for home exercise programs.
Built around documented minutes
From Daily Note to Supported Units
Evaluations and timed units are coded from the therapist's note, with each payer's unit rule applied to the minutes documented.
Full revenue cycle
Occupational therapy medical billing from referral to payment
California Billing Services manages the complete OT revenue cycle, from the referral to the final payment. Choose end-to-end billing or only the services your practice needs.
Insurance eligibility and therapy benefits verification
We verify coverage before the first visit, including therapy visit limits, remaining Medicare threshold, copays, deductibles and whether OT shares a visit limit with PT or speech.
Explore servicePrior authorization and visit tracking
We request authorizations from health plans and therapy utilization management programs, track approved visits and dates, and request extensions before visits run out.
Explore servicePlan of care and certification tracking
We track every plan of care, certification date, 90-day recertification and 10-visit progress report, and alert your team before a deadline is missed.
Charge entry and claim scrubbing
We reconcile visits in your EMR against billed charges, then check each claim for unit math, modifiers, NCCI edits and payer rules before submission.
Explore servicePayment posting and underpayment recovery
We post payments line by line, compare them with your contracted rates and the fee schedule, and appeal underpaid lines instead of writing them off.
Denial management and appeals
We sort denials by root cause, such as medical necessity, missing authorization, expired plans of care or unit limits, fix the source and appeal with the therapist's documentation.
Explore serviceAccounts receivable follow-up
We work open claims by balance and age, and we can take over aged AR from your previous billing company during the transition.
Explore serviceCredentialing and payer enrollment
We enroll occupational therapists with Medicare through PECOS, Medi-Cal through PAVE and commercial plans through CAQH, and we set up reassignment so payments go to your practice.
Explore servicePatient billing
We send clear statements, answer billing calls and set up payment plans for copays, deductibles and visits beyond a plan's limit.
Reporting and analytics
Monthly reporting covers collections by therapist, payer and code, plus visits per authorization, denial rate, days in AR and underpayments recovered.
California payers
California OT billing rules we handle every day
California adds its own licensing rules, children's programs and workers' comp limits on top of Medicare and commercial requirements. Each one affects whether an OT claim gets paid.
01
Medicare and Noridian
We bill Medicare through Noridian (Jurisdiction E), track the OT threshold separately from PT and speech, and follow Medicare's plan of care, progress report and supervision rules for OTAs.
02
Medi-Cal and Medi-Cal for Kids and Teens
We bill Medi-Cal managed care plans and fee-for-service Medi-Cal, request Treatment Authorization Requests where needed, and bill pediatric OT under Medi-Cal for Kids and Teens, California's benefit for medically necessary care under age 21.
03
California Children's Services and regional centers
We coordinate billing with California Children's Services and its Medical Therapy Program, and with regional centers that fund OT for children and adults with developmental disabilities, including Early Start for children under 3. Each has its own authorization process.
04
California Board of Occupational Therapy requirements
California requires OTs to hold advanced practice approval from the Board of Occupational Therapy for hand therapy, physical agent modalities and swallowing treatment. We confirm the approvals your therapists hold so services are billed only by qualified providers.
05
California workers' compensation
We bill workers' comp OT under California's Official Medical Fee Schedule and track the 24-visit limit on PT, OT and chiropractic care per injury, requesting additional authorization before the limit is reached.
Choosing a partner
How to choose an occupational therapy billing company
The best OT billing services understand therapy rules well enough to find revenue your current biller is missing. Ask any company you're considering these questions:
- 1Do you apply Medicare's 8-minute rule and each commercial plan's unit rule separately?
- 2How do you track the OT threshold apart from PT and speech?
- 3How do you handle CO modifier billing for OTA services?
- 4How do you track plans of care, recertifications and progress reports?
- 5Do you bill splints and orthoses, and to which contractor?
- 6How do you manage regional center and CCS authorizations?
California Billing Services can walk through each of these questions using examples from your own claims.
Outsourcing OT billing versus keeping it in-house
| In-house billing staff | California Billing Services | |
|---|---|---|
| Therapy coding expertise | Depends on one or two hires | Team focused on therapy billing |
| Unit rules by payer | Often one rule for all | Applied payer by payer |
| Plan of care tracking | Manual reminders | Tracked with alerts |
| California programs (CCS, regional centers) | Learned on the job | Built into our workflow |
| Staff turnover | Billing slows or stops | Team-based coverage |
| Cost | Salaries, benefits, software and training | Quoted for your practice |
Step by step
How we take over your OT billing
Agree responsibilities, access and timing before moving claims to a new billing team.
- 0
Claims review
We review recent claims, payments and authorizations and share what we find.
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Setup
We put agreements in place, connect to your therapy EMR and practice management system, and set up EDI, ERA and payer enrollment.
- 0
Parallel billing
We bill new visits while your current biller completes its open claims, so cash flow keeps moving.
- 0
Full transition
We take over all billing and begin working your aged AR.
- 0
Monthly review
You receive a performance report and a review call every month.
Results
OT billing results you can measure
Review the indicators that show how your OT revenue cycle is performing, against your practice’s baseline and agreed reporting scope.
| Metric | What we report |
|---|---|
| Clean claim rate | Share of claims accepted on first submission |
| Denial rate | Denials by payer and root cause |
| Days in accounts receivable | Average time from visit to payment |
| Net collection rate | Collected versus collectible revenue |
| Visits billed after authorization expired | Visits outside an active approval |
Compliance
Compliant, audit-ready OT billing
Therapy services draw close review from Medicare and commercial payers, especially for medical necessity, unit counts and plans of care. California Billing Services bills so every claim can be defended.
- Ongoing therapy billing training for our coding team.
- Claims checked against NCCI edits, MUE limits and Medicare therapy policy.
- Documentation feedback when a note doesn't support the units or skilled care billed.
- HIPAA-conscious handling of practice and patient data.
Systems
OT billing inside the therapy EMR you already use
We work from your therapy documentation system and your practice management system. Your therapists keep documenting the way they do now, and we bill from the notes they already write. Confirm your specific EMR with our team.
Visit-level visibility
Every Visit Matched to an Approval
Plans of care, authorizations and billed visits are tracked together, including CCS, regional center and Medi-Cal approvals for pediatric OT.
Pricing
Occupational therapy billing pricing
Your rate depends on visit volume, payer mix and the services you choose. California Billing Services provides a quote after reviewing your practice.
Locations
Occupational therapy billing services across California
California Billing Services bills for OT practices throughout the state, working remotely inside your systems.
Southern California
Los Angeles, Long Beach, Pasadena, Orange County, Irvine, San Diego, Riverside and San Bernardino
Bay Area and Northern California
San Francisco, Oakland, San Jose, Walnut Creek, Sacramento and Roseville
Central California
Fresno, Bakersfield, Modesto, Stockton and Visalia
See Los Angeles · San Diego · San Francisco · all locations.
Your next step
Find out what your OT claims are leaving unpaid
Send us recent claims. We'll show you which units, modifiers, authorizations and underpayments are costing your practice and how we'd recover them.
FAQ
Occupational therapy billing FAQs
Occupational therapy billing services are the coding, claim submission and payment follow-up for evaluations and treatment provided by occupational therapists and assistants. They include unit calculation, therapy modifiers, plan of care tracking, authorizations, denials and patient billing. California Billing Services provides these services for OT practices across California.
Can't find what you're looking for? Contact our billing specialists