Billing and Coding: Outpatient Physical and Occupational Therapy Services

Outpatient physical and occupational therapy services are covered when the medical record documents medically necessary, skilled therapy provided by a clinician, including an initial clinician-performed evaluation with objective baseline measures, goals, and documented progress. Claims must include valid ICD-10 diagnosis codes, required ordering/referring provider name and NPI when applicable, and detailed documentation (timed-code minutes, total treatment time, specific interventions, outcomes) to justify billed services; use of ABN and appropriate G-modifiers must follow CMS rules and may result in automatic denials as specified.

"Therapy services are covered when the medical record and claim consistently and accurately document that the services are covered and medically necessary."

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