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:

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

HCPCS CodeDescriptionYEAR
2002**2012B+20202024B+2025
Occupational Therapy Evaluation Codes
97165OT evaluation low complexity 30 minN/AN/A$93.11 $101.19 $100.60
97166OT evaluation mod complexity 45 minN/AN/A$92.75 $101.19 $100.60
97167OT evaluation high complexity 60 minN/AN/A$92.75 $101.19 $100.60
97168OT re-evaluation established plan of careN/AN/A$64.24 $69.90 $69.54
Tests & Measurements
95851Range of motion measurements$22.19 – $35.46$18.04 $22.38 $21.64 $23.61
95852Range of motion measurements$18.69 – $30.36$16.00 $19.49 $17.98 $20.05
96112Developmental test administration, first 60 minsN/AN/A$140.39 $123.83 $127.12
96113Developmental test administration, each additional 30 minsN/AN/A$62.80 $59.92 $53.37
96125Standardized cognitive performance testing, per 60 minsN/A$99.05 $111.88 $102.19 $99.63
96127Brief emotional/behavioral assessment, per standardized instrumentN/AN/A$5.05 $4.66 $4.53
97750Physical performance testN/A$32.34 $35.73 $33.95 $33.32
97755Assistive technology assessment$23.13 – $30.77$35.06 $39.34 $38.28 $37.52
Therapeutic Procedures
92526Oral function therapy$65.70 – $ 103.57$83.05 $89.50 $84.55 $82.81
97110Therapeutic exercises$23.56 – $31.86$30.63 $31.40 $29.29 $28.79
97112Neuromuscular reeducation$24.64 – $33.21$32.00 $36.09 $33.62 $32.02
97113Aquatic therapy/exercises$25.67 – $35.37 $40.85 $39.70 $36.62 $36.55
97140Manual therapy techniques$22.13 – $29.48$28.59 $28.87 $26.96 $27.17
97150Group therapeutic procedures$15.69 – $21.68$19.74 $18.77 $17.98 $17.47
97530Therapeutic activities$29.08 – $41.26$33.70 $40.42 $36.62 $34.61
97535Self-care management training$26.44 – $36.37$33.36 $35.01 $32.62 $32.02
97537Community/work reintegration$21.67 – $28.21 $28.93 $33.56 $31.62 $31.70
97542Wheelchair management training$22.27 – $29.26 $29.61 $33.92 $31.62 $30.73
97545Work hardening$0.00$0.00$0.00$0.00$0.00
97546Work hardening add-on$0.00$0.00$0.00$0.00$0.00
97550Caregiver training first 30 minN/AN/AN/A$52.93 $52.08
97551Caregiver training each additional 15 minN/AN/AN/A$26.30 $25.55
97552Group caregiver trainingN/AN/AN/A$22.30 $22.00
G0541Caregiver training, no patient present initial 30 minN/AN/AN/AN/A$52.08
+G0542Caregiver training, no patient present, each additional 15 minN/AN/AN/AN/A$25.55
G0543Group caregiver training, no patients present, untimedN/AN/AN/AN/A$22.00
Active Wound Care Management
97597Debridement, open wound, total wound(s) surface area: first 20 cm2 or lessN/A$75.22 $98.89 $100.86 $96.72
97598Debridement, open wound, each additional 20 cm2N/A$24.85 $47.28 $44.94 $43.34
97605Negative pressure wound therapy, total wound(s) surface area less than or equal to 50 cm2N/A$40.85 $44.75 $42.94 $42.05
97606Negative pressure wound therapy, total wound(s) surface area greater than or equal to 50 cm2N/A$43.57 $52.69 $50.93 $50.14
97610Low frequency non-thermal ultrasound, per dayN/AN/A$329.86 $427.08 $397.22
Orthotic Management & Training & Prosthetic Management
97760Orthotic management & training first encounterN/A$36.76 $50.53 $47.60 $45.93
97761Prosthetic training first encounterN/A$32.00 $42.95 $41.61 $40.43
97763Orthotic/prosthetic management, subsequent encountersN/AN/A$54.13 $52.26 $50.14

**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.

Decreasing Medicare Reimbursement for key OT/PT CPT Codes

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

HCPCS CodeDescriptionYEAR
2002**A*2012B+A*2020A*2024B+A*2025
Occupational Therapy Evaluation Codes
97165OT evaluation low complexity 30 minN/AN/A$114.66 $104.23 $100.60
97166OT evaluation moderate complexity 45 minN/AN/A$114.21 $104.23 $100.60
97167OT evaluation high complexity 60 minN/AN/A$114.21 $104.23 $100.60
97168OT re-evaluation established plan of careN/AN/A$79.11 $72.00 $69.54
Tests & Measurements
95851Range of motion measurements$39.80 – $63.61 $25.28 $27.56 $22.29 $23.61
95852Range of motion measurements$33.52 – $54.46 $22.42 $24.00 $18.52 $20.05
96112Developmental test administration, first 60 minsN/AN/A$172.88 $127.55 $127.12
96113Developmental test administration, each additional 30 minsN/AN/A$77.33 $61.72 $53.37
96125Standardized cognitive performance testing, per 60 minsN/A$138.82 $137.77 $105.26 $99.63
96127Brief emotional/behavioral assessment, per standardized instrumentN/AN/A$6.22 $4.80 $4.53
97750Physical performance testN/A$45.32 $44.00 $34.97 $33.32
97755Assistive technology assessment$41.49 – $55.19$49.14 $48.44 $39.43 $37.52
Therapeutic Procedures
92526Oral function therapy$117.85 – $ 185.78 $116.39 $110.21 $87.09 $82.81
97110Therapeutic exercises$42.26 – $57.15$42.93 $38.67 $30.17 $28.79
97112Neuromuscular reeducation$44.20 – $59.57$44.85 $44.44 $34.63 $32.02
97113Aquatic therapy/exercises$46.05 – $63.44$57.25 $48.89 $37.72 $36.55
97140Manual therapy techniques$39.70 – $52.88$40.07 $35.55 $27.77 $27.17
97150Group therapeutic procedures$28.14 – $38.89 $27.67 $23.11 $18.52 $17.47
97530Therapeutic activities$52.16 – $74.01 $47.23 $49.77 $37.72 $34.61
97535Self-care management training$47.43 – $65.24 $46.75 $43.11 $33.60 $32.02
97537Community/work reintegration$38.87 – $50.60$40.55 $41.33 $32.57 $31.70
97542Wheelchair management training$39.95 – $52.48$41.50 $41.77 $32.57 $30.73
97545Work hardening$0.00$0.00$0.00$0.00$0.00
97546Work hardening add-on$0.00$0.00$0.00$0.00$0.00
97550Caregiver training 1st 30 minN/AN/AN/A$54.52 $52.08
97551Caregiver training each additional 15 minN/AN/AN/A$27.09 $25.55
97552Group caregiver trainingN/AN/AN/A$22.97 $22.00
G0541Caregiver training, no patient present initial 30 minN/AN/AN/AN/A$52.08
+G0542Caregiver training, no patient present, each additional 15 minN/AN/AN/AN/A$25.55
G0543Group caregiver training, no patients present, untimedN/AN/AN/AN/A$22.00
Active Wound Care Management
97597Debridement, open wound, total wound(s) surface area: first 20 cm2 or lessN/A$105.42 $121.78 $103.89 $96.72
97598Debridement, open wound, each additional 20 cm2N/A$34.83 $58.22 $46.29 $43.34
97605Negative pressure wound therapy, total wound(s) surface area less than or equal to 50 cm2N/A$57.25 $55.11 $44.23 $42.05
97606Negative pressure wound therapy, total wound(s) surface area greater than or equal to 50 cm2N/A$61.06 $64.88 $52.46 $50.14
97610Low frequency non-thermal ultrasound, per dayN/AN/A$406.20 $439.89 $397.22
Orthotic Management & Training & Prosthetic Management
97760Orthotic management & training first encounterN/A$51.52 $62.22 $49.03 $45.93
97761Prosthetic training first encounterN/A$44.85 $52.89 $42.86 $40.43
97763Orthotic/prosthetic management, subsequent encountersN/AN/A$66.66 $53.83 $50.14

** – 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:

Number of UnitsTime Frame in Minutes
1 unit8 to 22 minutes
2 units23 to 37 minutes
3 units38 to 52 minutes
4 units53 to 67 minutes
5 units68 to 82 minutes
6 units83 to 97 minutes
7 units98 to 112 minutes
8 units113 to 127 minutes

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!  

12 replies on “Occupational Therapy and CPT Codes”

Thank you so much Sarah for putting this together – this is a tremendous amount of work! It finally gives concrete data to what so many OTs have felt for so long – that they are doing more for less which just isn’t sustainable.

My hope is that OTs will look at this data and trends and elect to take control of their future by becoming private pay. We need OTs to make a livable wage without burnout if the profession is going to keep making the incredible impact it already has.

Yes! I do believe that every OT needs to at least consider private pay, as part or all of their income. We just did a legal considerations for OT podcast, which convinced me that to really make that a reality we need to really back to advocacy to be able to opt out of Medicare. It currently feels like too much of a barrier for serving older adults!

I already knew this, yet its still sad to see. If you want to really give (and get )a gut punch , populate the % change since 2002 . It shows how the profession has a mostly decreased fee schedule in 20 years. I don’t know of many other professions that can bill LESS now vs 20 years ago.

Stephanie! How did you know this data already? I thought it was so hard to actually track down and understand.

What you suggested is EXACTLY my next step- I need to make the % decrease clear! I got a little hung up since there wasn’t a clear National Payment Amount (MAC: 0000000) in 2002 to draw comparisons to… so I think I may need to zoom in in certain locales, unless someone has a better idea!

I just posted this on AOTA about a post that referenced your post.
“I’m the owner of a medium-sized pediatrics-only practice in NC. We are only in network with Medicaid; however, all insurance companies (Medicaid and commercial plans) use the Medicare published rates to base their own fee schedules and reimbursement rates. My profit margin has decreased each year and now I’m lucky to have 2-3% profit margin. A clinic owner has to pay for related business expenses (EMR, eligiblity tools, website/email/digital fax, malpractice insurance, workers comp insurance, payroll, taxes, etc) but also expenses due to doing business with insurance ( audits and overpayment requests, numerous insurance portals and constant “glitches” that require more admin time, authorization requests and management, claim denials and other non sense that increases admin time and burden). So, when a clinic owner pays a therapist for billable time, its even worse than just calculating “reimbursed rate- OT rate = profit”. In NC , we receive $64.13 per evaluation. Thats it! I 100% lose money on evaluations. Our max reimbursement per unit of therapy is $24.10. So if we see a patient for 4 units, we receive about $96.00. But once I back out all the other expenses, there is not much profit left after payroll and other items have been paid out.

Another troubling insurance issue: In the last 3 years, I have been “selected” for 5 different insurance audits. The most recent (with NC Wellcare of Medicaid). Audits take a huge amount of admin time just to give the reviewers the info they need. Wellcare came back and said I owed them $135,000. Their hang-up was that I wouldn’t give them our supervision record details (it contains PHI about non-Wellcare patients). I did give them the supervision logs. The auditors then maintained that the money was owned because I co-signed all of the COTA’s notes, although I may not have been their direct supervisor. I explained that I did so to sign off as a compliance measure and that in NC or for Medicaid, no co-signature is required- only the treating therapist (which was in compliance). I had to retain legal counsel (at the cost of $35,000) as Wellcare served me with a summary judgment. I got an affidavit from the NC Board of OT restating that no co-signatures are needed for therapy notes. Anyhow, after 2 years , Wellcare said “ooops” and retracted their summary judgment. They then said they needed to give me a “formal education meeting” so I understood what I did wrong (I rejected that but told them I’d be happy to offer that to their reviewers). So, I “won” but financially I “lost” given the time and legal fees to defend something that a reviewer could have easily read in their own clinical policy.

So, yes, OT practices are suffering -especially if they don’t offer speech therapy or another therapy with reasonable fee schedules that can offset OT losses. AOTA and state boards should be advocating for better rates, yet year after year, the rates decline instead of increasing. Meantime, OT practices can’t pay reasonable rates to their OTL’s and COTA’s because they can’t. “

This is an excellent overview! It’s so important for therapists to understand how reimbursement is structured and the history so they can then learn where there is potential opportunity. Thrilled you did this!

Thank you so much for reading this, Dana!! I learned so much putting this together- and it really does highlight how critical advocacy is at this moment

Thanks for this post. I recently presented almost the same information after doing a deep dive into the reimbursement issues for both OT and PT, addressing chronic health conditions. It is the same story in PT. I didn’t go back historically, just presented the reality of the here and now. The newer RTM codes are a good idea, but they won’t be enough to make a significant difference.

Hi. This post came at exactly the time I was telling myself I need to learn more about insurance reimbursement. For the majority of my 27 year career as an OT, I have worked as a school-based OT or in early intervention (birth-2). In January I too, on some extra hours with a small SLP clinic as a contractor, and now I am in the world of insurance reimbursement. Last week I had an email from the owner regarding OT evals, that they are not getting reimbursed much for them anymore so to keep them time wise to just what is needed. Also, with certain insurances it doesn’t make sense for the practice financially to have OT scheduled the same day as SLP for a client because the OT is getting reimbursed at 50% of its rate. Yikes. I’m looking forward to learning more about the advocacy aspect because I am feeling nervous about our profession. And also feel like I need to know more about documenting to make sure the services are reimbursed as fully as can be. It may make sense to work on my own private pay vs as a contractor, where I am already taking a lower rate than larger companies can pay due to some other reasons. Thanks for the charts, it really helps with making the issue more easily understood.

Sarah, is anyone tracking the inflation of our credentials? I love that you have taken up this topic and I think you are doing a fantastic job! This is a difficult topic to unpack, especially once you leave Medicare. I have used some AI tools to perform some research in the past. If you have any interest in a research assistant – I’d be happy to help. Best luck, and know that this is a worthwhile endeavor.

Thanks, Sarah for compiling this detailed chart and explanation. I enjoyed reading all the comments and replies too and am more informed about this issue. Thanks to everyone that posted comments.
As an educator, I am alarmed at where the reimbursement for the profession is going. Being aware of this and advocating at all levels needs to be emphasized in all OT programs.

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