Occupational Therapy Guidelines

General Occupational Therapy Guidelines

Occupational therapy services are those services provided within the scope of practice of occupational therapists and necessary for the diagnosis and treatment of impairments, functional disabilities or changes in physical function and health status.

Occupational therapy is medically prescribed treatment concerned with improving or restoring functions which have been impaired by illness or injury or, where function has been permanently lost or reduced by illness or injury, to improve the individual’s ability to perform those tasks required for independent functioning. Such therapy may involve:

  • The evaluation and reevaluation as required, of a patient’s level of function by administering diagnostic and prognostic tests;
  • The selection and teaching of task oriented therapeutic activities designed to restore physical function;
  • The planning, implementing and supervising of individualized therapeutic activity programs as part of an over all “active treatment” program for a patient with a diagnosed psychiatric illness;
  • The planning and implementing of therapeutic tasks and activities to increase sensory input and improve response for a stroke patient with functional loss resulting in a distorted body image;
  • The teaching of compensatory technique to improve the level of independence in the activities of daily living, for example:
  • teaching a patient who has lost the use of an arm how to pare potatoes and chop vegetables with one hand;
  • teaching an upper extremity amputee how to functionally utilize a prosthesis;
  • teaching a stroke patient new techniques to enable the patient to perform feeding, dressing, and other activities ass independently as possible; or
  • teaching a patient with a hip fracture/hip replacement techniques of standing tolerance and balance to enable the patient to perform such functional activities as dressing and homemaking tasks
  • The designing, fabricating and fitting of orthotics and self-help devices; e.g., making a hand splint for a patient with rheumatoid arthritis to maintain the hand in a functional position or constructing a device which would enable an individual to hold a utensil and feed independently; or
  • Vocational and prevocational assessment and training, subject to the limitations specified in section 230.1B of Pub 100-02, Chapter 15.

Only a qualified occupational therapist has the knowledge, training and experience required to evaluate and, as necessary, reevaluate a patient’s level of function, determine whether an occupational therapy program could reasonably be expected to improve, restore, or compensate for lost function and where appropriate, recommend to the physician/NPP a plan of treatment.

The new personnel qualifications for occupational therapists and Occupational Therapist Assistants (OTAs) were discussed in the 2008 Physician Fee Schedule. See the Federal Register of November 27, 2007, for the full text. See also the correction notice for this rule, published in the Federal Register on January 15, 2008.

A complete outline of OT and OTA qualifications for Medicare are located in Pub 100-02, Chapter 15, Section 230.2 B-D

Occupational therapy may be required for a patient with a specific diagnosed psychiatric illness where such services are required and may be covered if coverage criteria are met.

Occupational therapy may include vocational and prevocational assessment and training.

Occupational therapy may include treatment of functional limitations would include those therapies which restore the patients ability to perform activities of daily living, which include eating, drinking, dressing, bathing, grooming, performing toileting and personal hygiene.

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