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Occupational Therapy Invoice Template

Evaluation and timed treatment codes, units, modifiers and NPI. Free PDF, no sign-up.

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Occupational therapy bills two kinds of code in the same session, and confusing them is what gets a claim reduced. The evaluation is service-based — one unit per episode, however long it took — while the treatment codes are timed in fifteen-minute units. An invoice that shows both the code and the units is one a plan can reconcile without asking.

INVOICE Issued
Invoice number:INV-0001
Date of issue:August 2, 2026
Date due:August 16, 2026
Currency:USD
Issued by
Northfield Occupational Therapy
18 Practice Road
48104 Ann Arbor, MI
United States
office@northfieldot.example
Bill to
Gerald Ostrowski
640 Huron Parkway
48108 Ann Arbor, MI
United States
g.ostrowski@example.com
Amount due
$1,277.00
Due in 14 days · Aug 16, 2026
For your claim
Provider NPI 1629384750, Michigan licence OT-4418822, tax ID 38-4471029. Modifier GO applies to the treatment codes. Referred by Dr. P. Sandoval, diagnosis M25.511. Place of service 11 except the home assessment, which is 12.
Description Qty Rate Tax Amount
97165 — OT evaluation, low complexity
One unit per episode; untimed
1$175.00—$175.00
97530 — Therapeutic activities
Timed, 15-minute units across six visits
14$44.00—$616.00
97535 — Self-care and home management training
Timed, 15-minute units across four visits
6$46.00—$276.00
Home assessment visit
Kitchen and bathroom access, written recommendations
1$210.00—$210.00
Subtotal$1,277.00
Total$1,277.00
Amount due $1,277.00
Terms
Payable on receipt. Timed codes are billed in 15-minute units under the 8-minute rule.
Invoice #INV-0001 · Northfield Occupational Therapy · Page 1 of 1

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What to put on a occupational therapy invoice

  • Your NPI and licence, and the practice tax ID
  • The evaluation code by complexity, billed once per episode rather than in units
  • Treatment codes with the units billed, since these are timed
  • The modifier the payer requires — Medicare Part B expects GO on outpatient OT
  • The diagnosis and the referring provider, where the plan requires a referral
  • Place of service, particularly where sessions are split between clinic and home

Questions

Is the evaluation billed in units?

No. An OT evaluation is reported once per evaluation episode as a single unit, whatever the assessment took — the complexity level is what changes the fee, not the clock. Reporting it in multiple units is a denial, and a common one.

How are the treatment codes counted?

In fifteen-minute units under the eight-minute rule, so a 38-minute block is not simply "one visit". Showing units on the invoice is what makes the total reconcile against the plan's own arithmetic.

What is the GO modifier?

It marks the service as delivered under an outpatient occupational therapy plan of care, and Medicare Part B expects it on OT claims. It costs nothing to carry on the invoice and its absence is a routine rejection.

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