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Occupational & Speech Therapy Billing Services Billing & RCM Services
Occupational and speech therapy claims are usually lost to three things: timed units that don't match the minutes in the note, visits billed past the KX threshold without the modifier, and treatment billed after a plan of care certification lapsed. Qualigenix bills OT and SLP services so the units, modifiers and certifications on each claim line up with the treatment note.
What is OT and SLP billing?
OT and SLP billing runs on four rules: the 8-minute rule for timed codes, a certified plan of care with recertification at least every 90 days, a progress report at least every 10 treatment days, and the KX modifier once a patient passes the annual therapy threshold. Qualigenix codes and bills occupational and speech therapy for outpatient clinics, pediatric practices and rehab groups, with CPC and CCS certified coders and 98.9% coding accuracy. Call 786-259-0231 to review your therapy claims with our team.
01
Timed and untimed codes
Therapy codes come in two kinds. OT evaluations (97165-97168), SLP evaluations (92521-92524) and speech treatment (92507) are untimed and billed once per session. Codes like 97530 and 97535 are timed in 15-minute units. Mixing the two rules is one of the fastest ways to under- or overbill a visit.
02
Visit authorizations and caps
Medicaid plans and many commercial payers authorize a set number of therapy visits, and some cap visits per year. A visit past the approved count is denied even when the care was needed, unless the extension was requested in time.
03
8-minute rule units
Medicare adds up all timed minutes in a visit and converts them to units: 8 to 22 minutes is one unit, 23 to 37 is two, and so on. A unit billed without the minutes to back it up is an overpayment. A visit billed short is revenue the practice earned and never collected.
04
Telehealth therapy rules
Occupational therapists, physical therapists and speech-language pathologists can bill Medicare for telehealth through December 31, 2027, under the Consolidated Appropriations Act, 2026. The claim needs the right place of service (POS 10 for the patient's home, POS 02 elsewhere) and modifier 95. Commercial and Medicaid rules for therapy telehealth vary by plan and state.
05
KX threshold tracking
Once a patient's combined PT and SLP charges, or OT charges, pass Medicare's annual threshold, every claim needs the KX modifier to confirm medical necessity. Above $3,000, claims can be pulled for targeted medical review. Practices that lose track of a patient's running total get denials on visits that would otherwise pay.
06
Plans of care and progress reports
Medicare requires a plan of care certified by a physician or NPP, recertification at least every 90 days, and a progress report at least once every 10 treatment days. In CMS's 2025 error data, missing therapy certifications, missing plans of care and missing progress reports were the top reasons therapy-type claims were paid in error.
06
Modifier denials
Every OT claim line needs modifier GO and every SLP line needs GN. Pairs of codes that NCCI bundles need modifier 59 or XU when the services were distinct, and that modifier has to be supported in the note.
07
Assistant billing rules
Services furnished in whole or in part by an occupational therapy assistant need modifier CO, and Medicare pays those services at 85% of the fee schedule. A missing CO is an overpayment finding waiting to happen.
PRECISION: WHAT QUALIGENIX DOES
How Qualigenix protects therapy revenue
Qualigenix closes each of these gaps with a check that runs before the claim is submitted.
Correct timed and untimed coding
Our coders separate untimed evaluation and speech codes from timed treatment codes on every visit, and bill each by its own rule. Qualigenix holds 98.9% coding accuracy and an over/undercoding rate under 2%.
Authorization and visit tracking
We track approved visits by patient and payer and request extensions before the last authorized visit, so the plan of care keeps getting paid.
Minute-to-unit validation
Every timed claim is checked against the minutes documented in the note, using the 8-minute rule for Medicare and each commercial payer's own unit rule where it differs.
Telehealth claim setup
We set place of service and modifier 95 by payer, and confirm that each commercial and Medicaid plan covers the therapy service by telehealth before the visit is billed.
KX and threshold monitoring
We track each Medicare patient's running therapy charges and apply the KX modifier when the threshold is crossed, with the medical necessity documentation it depends on.
Certification and progress report checks
Claims are held when a plan of care certification is unsigned, a recertification is past 90 days, or a progress report is overdue, and the clinic gets a list of what to complete.
Denial recovery and appeals
We work therapy denials by root cause and appeal with the missing certification, minutes or modifier support attached. Across our book of business, 79% of appealed denials are overturned.
CO modifier compliance
We flag visits where an OT assistant furnished part of the service and apply modifier CO, so the claim pays at the correct rate and does not come back as an overpayment.
CASE STUDY 01
How An Outpatient Therapy Clinic Recovered $106K On Missing KX Threshold Modifier
THE SITUATION
Therapy past the annual threshold (OT evals 97165-97167, speech 92507, dysphagia 92526) was billed without the KX modifier or medical-necessity support, so claims denied, and timed codes (97530) violated the 8-minute rule.
WHAT QUALIGENIX DID
We applied KX with documentation above the threshold, corrected timed-unit calculation, and attached certified plans of care.
Key Outcomes & Turnaround
Audited Practice Results
How A Pediatric Therapy Practice Recovered $159K On Therapy AR Backlog
THE SITUATION
OT and speech claims aged after denials went unworked, with evaluation and treatment charges under-captured post staffing change.
WHAT QUALIGENIX DID
We reworked aged denials, captured evaluation and treatment units, and standardized daily submission.
Key Outcomes & Turnaround
Audited Practice Results
How A Rehabilitation Center Recovered $87K On Plan-of-Care Authorization
THE SITUATION
Extended therapy plans and specialized evaluations proceeded without recertification or authorization, driving denials on continued care.
WHAT QUALIGENIX DID
We tracked certification/recertification and secured authorization for extended therapy and specialized evaluations.
Key Outcomes & Turnaround
Audited Practice Results
OT and SLP coding by service
Qualigenix codes occupational and speech therapy from the first evaluation through discharge.
OT evaluations (97165-97168)
OT evaluations are coded by complexity: low (97165), moderate (97166) or high (97167). Re-evaluations (97168) are billed only when the documentation shows a new clinical finding or a significant change.
COMPLIANCE
Compliance for OT and SLP claims
Qualigenix keeps occupational and speech therapy billing compliant by billing only the units, codes and modifiers the treatment note supports. We check every claim for a certified plan of care, a current recertification and a progress report within 10 treatment days, apply the 8-minute rule to timed codes, attach KX only when the threshold is crossed and necessity is documented, and apply CO to assistant-furnished services. Underbilling leaves earned revenue unpaid, and overbilling invites recoupment and audits. Qualigenix holds a 98.6% compliance and audit pass rate with an over/undercoding rate under 2%. All work is HIPAA compliant, with patient data handled under strict security controls.
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Audit Pass Rate
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Variance Threshold
Why therapy practices choose Qualigenix
Our therapy coders work the 8-minute rule, KX threshold and certification rules every day, so OT and SLP claims match the note on the first submission. Medicare's own error data shows how often therapy claims miss on documentation.
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IMPROPER PAYMENT RATE
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FROM DOC GAPS
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FROM CODING ERRORS
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PAID IN ERROR
QUESTIONS BUYERS ASK
Frequently asked questions
Qualigenix charges a percentage of collections, so the fee moves with what your clinic is actually paid. The rate depends on visit volume, payer mix and the services you need, and a billing specialist quotes it after reviewing your numbers.
Yes. We total the timed minutes in each Medicare visit and convert them to units by the 8-minute rule, and we follow each commercial payer's own unit rule where it differs.
We track every plan of care's certification date and alert the clinic before the 90-day recertification is due. Claims are held until the signed certification is on file.
We track each Medicare patient's running therapy charges for the year and add the KX modifier once the threshold is passed. We also confirm the note supports medical necessity before the modifier goes on.
Yes. Medicare covers OT and SLP telehealth through December 31, 2027, and we set the place of service and modifier 95 by payer after confirming the plan covers the visit.
Yes. We work old therapy AR by denial reason and payer, and across our clients we have reduced days in A/R from 54 to 36 with a 97.7% net collections rate.