Recently a question was posted on the NAHC List Serv regarding coverage of occupational therapy services when Medicare is the payer. The scenario presented was that a physical therapist made an initial assessment visit, provided a skilled service but then stated that no further physical therapy visits were required. He spoke with the physician and occupational therapy services were ordered. The poster asked whether the occupational therapy visits would be reimbursable. Because occupational therapy is both a dependent service and a qualifying service for Medicare beneficiaries, agencies need to be aware when occupational therapy services, as a stand-alone service, are covered.
To assist agencies in better understanding Medicare occupational therapy coverage criteria, we’ve prepared a job aid and short course below that reviews these basic concepts.
CMS (2011) Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2012, pp 68590-68591. Accessed at: https://www.federalregister.gov/documents/2011/11/04/2011-28416/medicare-program-home-health-prospective-payment-system-rate-update-for-calendar-year-2012.
CMS, (update 2017). Medicare Benefit Policy Manual Chapter 7 – Home Health Services. – Application of the General Principles to Occupational Therapy § 40.2.4.
CMS (last update 2017). 42 CFR § 409.42 – Beneficiary qualifications for coverage of services. §409.42(c)(4)