Occupational Therapy and CPT Codes

It is essential that occupational therapy professionals understand CPT codes. 

The reason is simple: if you do not understand CPT codes, you will not understand the forces shaping OT today—and how we fit into the larger healthcare context.

More importantly, you will not be equipped to advocate for fair and expanded reimbursement of critical OT services. (And, as you will find out below, advocacy is more crucial than ever—because we are seeing an alarming decline in our inflation-adjusted rates.)

In this post, we will walk you through the basics of using CPT codes, explain why they are so important, and supply you with a chart of 2025 reimbursement rates. (Both the actual numbers and adjusted for inflation.)

Note: This article is part one of a two-part series. In part two—which we will release later this year—we will dive deeper into the nuances of coding and billing, walk through specific coding examples, provide advocacy resources, and discuss the future of OT coding.

What are CPT codes?

In most OT clinical encounters, the patient comes to therapy with a diagnostic code from ICD-10.

Then, you as the therapist will code your treatment using Current Procedural Terminology (CPT®) Codes. These codes—which have been around since the 1960s—offer a standardized way to denote the care provided.

Today, Medicare and Medicaid require CPT codes as a condition of reimbursement. Thus, CPT codes are a common way of billing for acute care OT, outpatient OT, home health OT, OT in a skilled nursing facility, and even school-based OT (when the services are billed to Medicaid).

The Centers for Medicare & Medicaid Services (CMS) offers many resources to assist with CPT coding, including:

• A comprehensive CPT code search tool

• A guide for coding and billing for therapy services

• A guide for coding outpatient occupational therapy

While many major commercial insurers also use CPT codes, they often reimburse the corresponding services at varying rates. (We’ll talk more about that below.)

Who does not need to use CPT codes? 

As described above, CPT codes are mandated for US-based OTs in most practice areas.

CPT codes are also used outside of the United States, but not universally. (Note that CPT codes are copyrighted by the American Medical Association.)

In the United States, one notable exception to required CPT code usage is private pay occupational therapy. To my knowledge, no state practice act mandates the use of CPT codes, so OTs can legally provide services without recording these codes. That said, if you don’t use CPT codes as a private-pay therapist, the client likely will not be able to submit a superbill to their insurance in an effort to obtain reimbursement for their out-of-pocket expenses. (Some insurances provide beneficiaries with reimbursement for services obtained on a private or cash-pay basis.)

Another notable exception would be community-based OTs, whose services are typically funded by grants or private sources.

2025 charts of OT CPT codes with reimbursement rates

Okay, let’s answer the big questions: What are the codes for OT services, and how much do you get paid for each?

Below, we have compiled all of the occupational therapy CPT codes and corresponding reimbursement rates in 2025 (according to CMS).

We obtained these dollar amounts using the CMS.gov Physician Fee Schedule Search Tool, which you can access here.

To demonstrate how OT payment rates have changed over time, we are also including historical reimbursement data from a few key years:

• 2002: This is when the Balanced Budget Act of 1997 was fully in place. This law created spending limits and new rules for therapy payments under Medicare.

• 2012: The Affordable Care Act (ACA) was in full swing. It expanded access to health care and added new rules for coverage and cost—making 2012 a good year to see how payment shifted.

• 2020: The COVID-19 pandemic caused major healthcare changes, including temporary payment updates and new ways to provide therapy, like telehealth. It’s important to see how reimbursement looked during that time.

• 2024: This is the most recent full calendar year of data. Comparing 2024 to 2025 helps illustrate recent changes in how services are valued.

These rates reflect what Medicare pays in a non-facility setting (e.g., a private clinic). Keep in mind, these numbers may not match what Medicaid or private insurance pays. Use this list to better understand how Medicare values each service—but always talk to your billing expert to get the full picture in your setting.

A few quick notes before you dive in:

• Not every CPT code can be used in every setting.

• Some codes have special rules (e.g., modifier or bundled service requirements).

• The rates listed here may be higher or lower than what Medicaid or private insurance actually pays.

• Using a code doesn’t guarantee payment—coverage depends on the payer, setting, and medical need.

• Different insurers may have different rules for the same code.

• Reimbursement rules and rates can change, so always double-check the most up-to-date info.

• Accurate documentation is key for getting paid.

• This information is for general education—it does not constitute official legal or billing advice.

• There is a difference between timed and untimed codes (keep reading to learn more).

Occupational Therapy Medicare Non-Facility Reimbursement Rates (Actual)

The following reimbursement data is primarily** based on the baseline National Payment Amount (MAC: 0000000) for non-facility settings. Reimbursement rates will vary based on MAC locality. Find the fee schedule per MAC locality here.

🟢 Represents increase over prior column
🔴 Represents decrease from prior column

**Values for 2012, 2020, 2024, and 2025 reflect the national payment amount (MAC: 0000000) for non-facility settings; 2002 data reflects a range from the lowest reimbursement to the highest reimbursement according to specific Medicare Administrative Contractor (MAC) locality, excluding Puerto Rico, due to lack of a national rate.

+ – When available, B years reflect the most accurate and updated rates, including any mid-year corrections or legislative changes (like budget acts or conversion factor adjustments).

How have reimbursement rates really changed?

The chart below shows inflation-adjusted reimbursement rates for the same OT services featured in the previous chart. So, we’ve converted all of the dollar amounts from 2002, 2012, 2020, and 2024 into 2025 dollars—enabling you to make a true apples-to-apples comparison. When we look at the numbers this way, it’s easy to see that OT reimbursement rates have not kept up with the rising cost of living. In fact, rates have actually decreased over time when adjusted for inflation.

When you see our key CPT down by about 40% when adjust for inflation, it helps clarify the need for grassroots advocacy, and lending you voice to initiatives like commenting on physician fee schedule.

Occupational Therapy Medicare Non-Facility Reimbursement Rates (Adjusted for Inflation)

The following reimbursement data is primarily** based on the baseline National Payment Amount (MAC: 0000000) for non-facility settings, adjusted for inflation (see our calculations below the chart). Reimbursement rates will vary based on MAC locality.

🟢 Represents increase over prior column
🔴 Represents decrease from prior column

** – Values for 2012, 2020, 2024, and 2025 reflect the national payment amount (MAC: 0000000) for non-facility settings; 2002 data reflects a range from the lowest reimbursement to the highest reimbursement according to specific Medicare Administrative Contractor (MAC) locality, excluding Puerto Rico, due to lack of a national rate.

+ – When available, B years reflect the most accurate and updated rates, including any mid-year corrections or legislative changes (like budget acts or conversion factor adjustments).

A* – All values shown are adjusted for inflation to reflect 2025 dollars, using the Bureau of Labor Statistics CPI Inflation Calculator.

Timed vs. untimed codes

It is important to understand the difference between timed and untimed CPT codes.

On a basic level, untimed (or service-based) codes reimburse the same no matter how long you spend on the activity. For timed codes, on the other hand, you typically must spend at least 8 minutes providing the service in order to bill for one unit (according to Medicare’s “Rule of Eights”). When the total time spent providing a service exceeds eight minutes, you can reference this chart to determine how many units you are allowed to bill:

There is a lot of detail to understand here, so I recommend reading this post on the 8-minute rule to learn more.

Conclusion

Understanding—and accurately applying—CPT codes is crucial to obtaining the full reimbursement we have rightfully earned for each encounter. At the same time, the downward trend in CPT code reimbursement rates for occupational therapy is a clear threat to the financial sustainability of OT practice.

So, in addition to leveraging CPT codes to the fullest today, we also must look forward to the future and take an active role in advocating for different and better OT reimbursement methodology. We’ll talk more about this important effort and what you can do to support it in part two of this series, which we plan to release later this year.

In the meantime, I hope you’ll pop into the comments and let us know what questions you have so we can address them in our follow-up article!