Multitiered systems of support (MTSS) are an effective and efficient framework burgeoning in schools across the United States. School-based occupational therapy practitioners (SBOTPs) have much to offer in the MTSS framework and can influence school-based outcomes. Understanding the current literature and its implications for practice is imperative for SBOTPs. The purpose of this scoping review was to determine what is in the literature related to SBOTP and MTSS in the United States, the implications for practice, and directions for future research. The authors searched PubMed, CINAHL, Nursing and Allied Health (ProQuest), PsycINFO, Scopus, ERIC, and Education Source using keywords multitiered support systems, problem-solving teams, early intervening services, and response to intervention, and school-based occupational therapy. Guided by Arksey and O'Malley's scoping review methodology, the authors identified, screened, and selected peer-reviewed articles related to school-based occupational therapy and MTSS in the United States. Twenty-three articles published between 2008 and 2022 met the inclusion criteria. Expert opinion articles (n = 8), qualitative studies (n = 5), and quantitative studies (n = 10) yielded valuable information to enhance SBOTPs success in MTSS. Many distinct areas for future research were uncovered. This review provides SBOTPs with implications to consider, such as their ability to build teacher capacity, the vast array of student skills that could be addressed through MTSS, the need to articulate their scope and role in MTSS, the significance of data and documentation and the potential to impact outcomes in more significant numbers of students in relatively short periods.