Methodology
How OTConnected computes OT reimbursement rates
Every number in our Reimbursement Rates tool comes from public federal disclosures, aggregated with a documented, repeatable method. Data current as of June 2026.
What this data is
Three public sources feed the tool: payer Transparency-in-Coverage (TiC) machine-readable files, which federal rules require insurers to publish monthly and which contain every contracted rate; the CMS Physician Fee Schedule (PFS), which defines Medicare payments; and the NPPES registry, which maps every provider's NPI to a practice location.
How we compute commercial rates
From each payer's TiC files we keep professional-claim negotiated rates for a curated set of occupational-therapy CPT codes (evaluations, therapeutic procedures, cognitive intervention, orthotics, assistive technology, and common modalities). Each rate is attributed to the provider's practice state via NPPES, and we publish the median plus the 25th–75th percentile range per payer, code, and state. Cells backed by few records are flagged as low-confidence.
How we compute Medicare rates
Medicare rates use the CMS formula directly: (work RVU × work GPCI + practice-expense RVU × PE GPCI + malpractice RVU × MP GPCI) × conversion factor, computed for every Medicare locality with non-facility practice-expense values (the outpatient and private-practice setting where OTs bill). State figures are medians across that state's localities.
What each payer's data covers
Coverage differs by payer, and we'd rather tell you exactly how. Cigna: the issuer's own national OAP and PPO network files — tens of thousands of negotiated rates per service, state-level. UnitedHealthcare: a network sample across UHC's legal entities (the Optum Physical Health therapy files plus one bounded general-network file per entity) — state-level, but a sample of UHC's full employer book, which is too large for anyone to parse in full. Aetna: a small fixed sample of entity filings shown as a single national figure only, because Aetna's file listing can't be enumerated programmatically. Medicare: the complete CMS fee schedule — every locality, exact published amounts.
How often it updates
Monthly. Payers republish TiC files each month; CMS updates the fee schedule quarterly; NPPES publishes monthly. Our pipeline re-ingests all three and the tool shows its data-as-of month.
Honest limitations
Commercial figures are illustrative samples from public filings, not your contract: some payers are represented by bounded samples (Aetna is shown as a national sample only), modifiers and plan specifics change real payment, and a median is a benchmark — not a guarantee. We show record counts so you can judge each cell's weight.
How to cite this data
Cite as "OTConnected OT Reimbursement Rates" and link to otconnected.com/transparency. Journalists and researchers: we're happy to provide context on the data — ask in our community or via any OTConnected channel.
Common questions
How does OTConnected calculate OT reimbursement rates?
We parse each payer's public Transparency-in-Coverage files, keep professional-claim negotiated rates for a curated set of OT CPT codes, attribute each rate to the provider's practice state via the NPPES registry, and publish the median plus the 25th-75th percentile range per payer, code, and state.
How much of each payer's data does the tool include?
It varies by payer and we disclose it: Cigna is the issuer's own national OAP/PPO network files (tens of thousands of rates per service, state-level); UnitedHealthcare is a network sample across UHC legal entities — therapy carve-out files plus one bounded general-network file per entity (state-level, but a sample of UHC's full employer book); Aetna is a small fixed sample shown as a national figure only; Medicare is the complete CMS fee schedule for every locality.
What is the difference between a Medicare rate and a negotiated rate?
Medicare rates are computed deterministically from the CMS Physician Fee Schedule formula (RVUs x GPCIs x conversion factor) — they are exact published amounts. Negotiated rates are medians of contracted amounts payers disclose in Transparency-in-Coverage filings, so they are samples, not guarantees.
Can I cite or reference this data?
Yes — cite 'OTConnected OT Reimbursement Rates (otconnected.com/transparency)' and link to the page. The underlying sources are public federal disclosures; our aggregation methodology is documented on this page.