A threshold that is OT's alone
Medicare tracks OT spending separately from PT and speech. For 2026, a patient's OT claims past $2,480 need the KX modifier, and claims over the threshold without it are denied.
OT claims carry their own threshold and modifiers
Occupational therapy runs on its own Medicare KX threshold and GO modifier, and services furnished partly by an assistant are paid at a reduced rate. Taiga drafts codes from your notes for therapist approval, scrubs each claim, and works every denial. OT is not on its published specialty list, so the first step is a straight fit check.
Book a demoWhere OT claims get caught
OT shares the outpatient therapy rulebook with PT and speech, then adds a few twists of its own.
Assistant time and the CO modifier
When an occupational therapy assistant furnishes more than a small share of a service on their own, the line takes the CO modifier and Medicare pays 85 percent of the fee schedule amount. Notes have to show who did what.
Caregiver training on full time
Since January 2025, caregiver training codes are billable only when the full time in the code descriptor is delivered. The usual midpoint rule for timed codes does not apply to them.
Who owns what in an OT handoff
The therapist's documentation decides the claim. Billing turns it into clean lines.
The practice keeps
Evaluations, plans of care, certifications, and daily notes that record minutes and who furnished them. Therapists approve every code before it is sent.
Taiga takes on
Eligibility checks, claim scrubbing against payer rules, submission, patient statements, and every denial and appeal, including the small ones.
Needs a decision
Settle who watches each patient's running OT total against the KX threshold and who tracks commercial visit limits and authorizations.
Before an OT fit call
Bring de-identified notes from a typical visit, one with an assistant involved, and a recent denial. Leave patient details out of the booking form.
Which settings do you bill from?
Separate clinic visits, home visits, and any school or pediatric contracts, since each can carry its own payer rules.
How often do assistants treat?
Estimate the share of visits where an OTA furnishes part of the service and how that is noted today.
Which services sit outside core OT?
List caregiver training, remote therapeutic monitoring, splints, and anything you dispense, with the current billing path for each.
Practices that tend to fit
Outpatient OT practices, including hand therapy and pediatric clinics, that want an experienced team on denials without changing EHRs. Onboarding takes about two weeks to the first claim, and Taiga can take over open A/R or run in parallel.
Outside this page
Facility and institutional therapy claims follow different rules. This page covers private practice professional claims and does not confirm Taiga support for OT.
Questions about occupational therapy billing
Does OT share a KX threshold with physical therapy?
No. Medicare keeps one threshold for PT and speech combined and a separate one for OT. Each is $2,480 for 2026.
When does an OT claim need the CO modifier?
When an occupational therapy assistant furnishes more than 10 percent of a service independently of the therapist. Those lines are paid at 85 percent, with limited exceptions CMS describes for the final units of a timed service.
Can OTs still bill Medicare for telehealth?
CMS says current law lets OTs furnish Medicare telehealth services through December 31, 2027. Commercial payer rules vary, so check each plan.
Does Taiga bill for occupational therapy practices?
OT is not on Taiga's published specialty list. Bring your service mix and payers, and Taiga will tell you straight whether it fits.
Bring your OT service mix
Share your payers, assistant model, and visit volume. Taiga will tell you straight whether it fits.
System guides show possible billing handoffs, not proven specialty compatibility.