Occupational therapy billing involves accurate coding and processing of claims for therapy services like functional evaluations, therapeutic exercises, and activities of daily living (ADL) training. It requires expertise in CPT and ICD-10 coding, correct use of modifiers such as 59 and GP, and strict adherence to time-based coding rules and payer requirements. At ProMantra, we handle precise coding, audits, quick claims, and denial management so your practice can focus on patient care while we optimize your revenue.
We help reduce denials, manage therapy caps, and maintain full compliance with payer rules, so your claims are processed quickly and correctly
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ProMantra provides end-to-end billing solutions designed specifically for occupational therapy practices. We ensure accurate CPT and ICD-10-CM coding, efficient claims management, and strict compliance with healthcare regulations to protect your revenue
ProMantra delivers occupational therapy billing solutions that address the unique challenges of therapy practices. We manage the details of coding, documentation, and payer rules so you can focus on delivering care
Our team understands the specific requirements of occupational therapy billing, including correct use of CPT codes like 97110 for therapeutic exercises, 97112 for neuromuscular re-education, 97530 for therapeutic activities, and 97535 for self-care training. We apply appropriate modifiers, such as GP, GO, and 59, and ensure documentation supports medical necessity. We also manage functional reporting requirements for Medicare, including G-codes and severity modifiers.
We build billing workflows that fit your practice’s size, patient volume, and payer mix. We track therapy caps, session limits, and authorization requirements to avoid rejections and ensure timely payments.
We focus on minimizing denials by identifying and addressing issues such as incomplete documentation, time-based coding errors, and medical necessity challenges. Our team follows up on denials, submits accurate appeals, and works to recover lost revenue while reducing future errors.
We use secure billing systems, claims tracking tools, and payer-specific checks to manage each claim from start to finish. Our team provides responsive support for your practice, helping navigate coding updates, payer policy changes, and compliance requirements to ensure accurate billing and steady cash flow.
ProMantra stands apart by delivering occupational therapy billing solutions that go beyond basic claims processing. We address the unique complexities of therapy billing, from time-based coding and functional reporting to payer-specific rules and documentation requirements, helping practices navigate a system where errors can easily lead to revenue loss and compliance issues.
We specialize in occupational therapy’s unique time-based coding model, ensuring accurate unit calculations for CPT codes 97110, 97112, and 97530. We understand that a 15-minute service does not always equate to a single unit, and we apply correct rounding rules and modifier usage according to payer guidelines. This precision helps prevent overbilling errors and reduces audit risks.
ProMantra understands the complexity of Medicare’s functional reporting requirements, including the correct application of G-codes (e.g., G8978 for self-care goal status) and severity modifiers like CH and CI. Many billing companies miss these details, leading to rejected claims and revenue delays. We ensure compliance by reviewing progress notes, verifying plan of care updates, and aligning documentation with therapy goals.
Our denial resolution strategies go beyond generic appeal letters. We conduct root cause analysis specific to occupational therapy denials, such as missing therapy cap exception documentation, lack of progress note updates for continued services, or billing for therapy without updated physician certifications. We don’t just fix denials—we identify systemic issues and implement process improvements to prevent them from happening again.
We help your practice stay prepared for Medicare and commercial payer audits by reviewing documentation for compliance with therapy-specific policies, such as the need for functional outcome measures, progress reports, and signatures on plans of care. Our team monitors payer policy changes, educates your staff on coding updates, and conducts internal audits to identify and resolve risks before they impact your revenue.
ProMantra provides detailed, therapy-focused analytics, including denial patterns by CPT code, payer-specific rejection reasons, and functional reporting compliance rates. This level of insight empowers your practice to make informed decisions, reduce claim errors, and maintain a healthy revenue cycle.
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ProMantra revolutionized our prior authorization process. Their expertise and automation tools significantly improved our approval rates and boosted revenue. We now focus on patient care without the hassle of administrative delays.
ProMantra has been a game-changer for our practice. Their proactive approach and expertise in denial management significantly reduced our claim denials and improved our bottom line. We highly recommend their services!
ProMantra’s medical coding services have streamlined our entire revenue cycle. Their precision and efficiency have significantly reduced our claim denials and boosted our revenue. Highly recommended
Services include pre-employment physicals, drug and alcohol testing, vaccinations, work-related injury treatment, and routine health assessments for employees.
ICD-10-CM for diagnoses, CPT for procedures, and HCPCS for additional services and supplies are commonly used in Occupational Health billing.
ProMantra adheres to Occupational Health-specific guidelines, including worker’s compensation and insurance requirements, ensuring all claims meet industry standards for compliance.
ProMantra specializes in managing worker’s compensation claims, ensuring proper documentation, accurate coding, and timely submission to ensure reimbursement.
Occupational therapy billing is complex, but with ProMantra’s support, it doesn’t have to be. From CPT coding to compliance checks, we help you stay audit-ready, reduce denials, and protect your revenue.
Promantra, established in 2003, specializes in AI and RPA driven revenue cycle management and IT solutions for the healthcare sector. We offer comprehensive end-to-end services, including medical billing, coding, eligibility verification, accounts receivable management, and denial management. Our commitment to quality and security is underscored by ISO 9001 and ISO 27001 certifications.
