Occupational therapy practice management software

Sensory gyms, hand clinics and shared schedules

The private OT practices served here resemble their speech and ABA neighbours: pediatric sensory and developmental clinics, cash-based hand therapy and specialty practices, and multi-discipline clinics where OT shares a schedule with speech or ABA. Pediatric practices delivering birth-to-three services in family homes under a state Part C program bill differently again, and early intervention billing software covers that payer mix.

Hospital-based and inpatient OT runs on institutional systems with requirements this product does not cover, and is not the intended audience.

What an OT clinic runs on here

Timed units in OT, and the rule that is not the same rule

OT bills the same timed-code structure as physical therapy, and the counting rule under Medicare Part B outpatient therapy applies to occupational therapy in the same way. That much genuinely transfers. What does not transfer is the assumption that every payer counts the same way.

Two counting methods exist, and they disagree. Medicare totals all timed minutes in the visit and converts that total into units on a single ladder, which means minutes from different services combine, and a service delivered for only a few minutes can still contribute to a billable unit. The other method, used by a number of commercial payers, evaluates each code on its own against its own increment, so short services do not combine and may not be billable at all.

The same visit can therefore yield a different number of units depending on whose card the patient carries. A practice that learned one method and applies it everywhere is either leaving units unbilled or billing units it cannot support, and which of those is happening is usually invisible until an audit.

Untimed services do not enter the calculation. Evaluations and codes billed once per session sit outside the timed total, and mixing them in is a common source of quiet overbilling.

The minutes have to exist somewhere defensible. Whichever method a payer uses, the arithmetic starts from documented treatment time. A note that records what was done without recording how long is not auditable, and rounding up to reach the next unit is the single most recoverable thing in outpatient therapy billing.

Medicare gives OT its own spending threshold. For 2026 the KX modifier threshold is $2,480 for occupational therapy, counted separately from the $2,480 that physical therapy and speech-language pathology share. Above it, a claim without the KX modifier (attesting that further therapy is medically necessary) is denied, and above $3,000 a claim may be picked for targeted medical review. OT lines also carry the GO therapy modifier.

What MegAligna does with all of this is narrower than the rules. Units come from the session’s delivered minutes, rounded the way you set for each payer rather than by one global setting. It does not pool minutes across codes the way Medicare does, it does not track a patient’s spend against the KX threshold, and it does not add GO or KX; your biller does. A clinic seeing Medicare patients should treat the unit count as a draft for the biller to confirm.

The billing side has its own page: occupational therapy billing software covers unit computation and the superbill handoff, and the 8-minute rule covers the arithmetic that decides how many units a documented session is worth.