If you’re a medical biller or coder working with institutional claims, understanding revenue codes 0430 is essential. This code specifically refers to Occupational Therapy (OT) services and plays a crucial role in accurate claim submission and reimbursement. In 2025, new payer policies and updated CMS guidelines make it more important than ever to get this right.
This article will break down everything you need to know about revenue code 0430—from definitions and CMS mandates to payer nuances and claim best practices. Along the way, you’ll find links to authoritative sources and helpful internal resources from CMS1500ClaimBilling.com for even deeper dives.
What Are Revenue Codes 0430?
Revenue codes categorize charges on institutional claims, specifically on the UB-04 (CMS-1450) form. Revenue code 0430 identifies General Occupational Therapy Services. It tells payers that the claim line relates to OT interventions, which helps them apply the correct coverage and reimbursement rules.
The National Uniform Billing Committee (NUBC) classifies 0430 as the primary OT code. Subcodes such as 0431 (Visit Charge) or 0434 (Evaluation/Reevaluation) exist but 0430 is the catch-all when a more specific subcode doesn’t fit.
Why is Revenue Code 0430 Important?
Because occupational therapy can involve various settings and service types, using the correct revenue code ensures payers recognize the service type. This affects claim routing, edits, and ultimately your facility’s reimbursement. Errors in this code often trigger denials or delays.
CMS Guidelines for Revenue Code 0430 in 2025
The Centers for Medicare & Medicaid Services (CMS) provide detailed billing instructions for therapy services. According to the latest CMS Therapy Services Guidelines (2025 update), revenue code 0430 must be used with the appropriate healthcare common procedure coding system (HCPCS) or Current Procedural Terminology (CPT) codes that specify the type of OT service rendered.
Moreover, CMS mandates the inclusion of therapy modifiers such as GO (Occupational Therapy) alongside CPT codes on all claims containing revenue code 0430. Missing this modifier often results in claim rejection or delayed processing.
CMS further clarifies that although specific sub-revenue codes (0431–0439) may be used for detailed billing, 0430 remains the standard for general OT services and must be accepted by Medicare Administrative Contractors.
Common CPT and HCPCS Codes Paired with Revenue Code 0430
Institutional claims with revenue code 0430 generally include CPT codes such as:
- 97110 – Therapeutic exercises
- 97530 – Therapeutic activities
- 97535 – Self-care/home management training
- 97165-97168 – OT Evaluation codes (complexity-based)
When billing, make sure to include the correct modifier GO for occupational therapy services. This aligns with CMS’s 2025 coding requirements and reduces risk of claim denials.
Payer Policies and Updates for 2025
UnitedHealthcare
UnitedHealthcare follows NUBC guidelines closely. Their 2025 outpatient therapy policy highlights that revenue code 0430 must be submitted with an appropriate CPT code and modifier. Claims missing any required elements are subject to editing or denial. For detailed policy language, visit UnitedHealthcare Claims Policies.
Anthem Blue Cross
Anthem’s 2025 medical policy specifies revenue code 0430 as necessary for occupational therapy claims. They emphasize that group therapy sessions require revenue code 0433, but 0430 is the standard for individual therapy services. Anthem also uses claim edits to detect mismatches and prevent overpayments. More details at Anthem Provider Policies.
State Medicaid Programs
Each state Medicaid program has its own nuances. However, most adhere to NUBC standards, requiring 0430 for OT services. It is critical to review state Medicaid provider manuals annually, as policies can change. The Medicaid State Overviews page is a good starting point.
Commercial Insurers
Other commercial payers like EmblemHealth and Cigna have increasingly adopted automated claims edits that cross-check revenue codes with CPT codes and modifiers. Staying current with payer bulletins and companion guides is essential to avoid denials or payment delays.
Best Practices for Claim Submission with Revenue Code 0430
Using the UB-04 Form
On the UB-04 claim form, revenue code 0430 goes in Form Locator 42, alongside the total charge amount for OT services. The associated CPT/HCPCS codes with appropriate modifiers go in Form Locator 44. Ensure that the place of service (Form Locator 46) matches the service location.
Electronic Claims (837I)
When submitting claims electronically, revenue code 0430 is transmitted in the SV101 segment (loop 2400). CPT codes and modifiers are sent alongside in the service line segments. Follow payer-specific companion guides to avoid errors.
Common Pitfalls to Avoid
Many providers encounter denials due to missing the GO modifier or incorrect pairing of CPT codes. Others forget to update their billing software for new CPT codes or ignore payer updates. Regular audits and pre-submission claim scrubbing improve acceptance rates.
Frequently Asked Questions About Revenue Code 0430
Q: Can I use 0430 for all occupational therapy services?
A: Generally yes, unless a more specific subcode (e.g., 0431 for visit charges) applies or payer policies require otherwise.
Q: What modifier is mandatory with revenue code 0430?
A: Modifier GO is required for occupational therapy services billed with 0430, especially for Medicare claims.
Q: Is revenue code 0430 used for Durable Medical Equipment (DME)?
A: No. DME uses different revenue codes, like 0274 for rental equipment. 0430 is strictly for therapy services.
Q: How do I bill group occupational therapy?
A: Use revenue code 0433 for group OT services, paired with the appropriate CPT and modifier codes.
Q: Where can I find official CMS updates on revenue code 0430?
A: Visit the CMS Therapy Services page for ongoing updates and manuals.
Additional Resources from CMS1500ClaimBilling.com
- UB-04 Billing Guide – Comprehensive tips on filing institutional claims
- Occupational Therapy Billing Best Practices – Avoid common errors and speed up reimbursement
- CMS-1500 Claim Form Tips – Useful for professional therapy billing in physician offices
Staying current on revenue codes 0430 and related billing requirements will help you streamline claims and maximize reimbursements in 2025. Always consult payer policies directly and monitor CMS publications to ensure compliance.