decisionhealth Newsletters, Answer Books - 2006 Issue 7 (July)
Medicare_Benefit_Policy_Manual / Chapter_15 / 230.4_-_Covered_Occupational_Therapy
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Article Overview
This Medicare policy article outlines the scope of covered occupational therapy services and the criteria used to determine when therapy is considered reasonable and necessary. It is intended for providers, therapists, and billing/coding professionals who need to understand the general coverage framework, the types of services addressed, and the policy’s treatment of support personnel, supplies, and related billing issues.
Why This Topic Matters
It helps readers determine whether occupational therapy services fall within Medicare coverage policy and understand the broad compliance context for documentation, treatment planning, and billing.
Article Sections
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A - General
Describes the general scope of occupational therapy services covered under the policy and the types of therapeutic activities and evaluations discussed.
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B - Coverage Criteria
Outlines the broad Medicare criteria for determining whether occupational therapy is considered reasonable and necessary, along with related coverage limitations.
What You Will Learn
- The general framework Medicare uses to evaluate occupational therapy coverage
- The broad categories of occupational therapy services addressed in the policy
- The types of circumstances that affect whether therapy is considered medically necessary
- How the policy distinguishes covered therapy from noncovered services
- How support personnel and supplies are treated in covered therapy services
Who Should Read This
- Occupational therapists
- Physical medicine and rehabilitation providers
- Medicare billing professionals
- Healthcare compliance staff
- Practice managers
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