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National Occupational Therapy Month 2015April 2015 is being observed as the 35th Annual Occupational Therapy Month in the United States. Sponsored by the American Occupational Therapy Association, Inc (AOTA), this campaign is a strong platform to educate the general public about the pivotal role that occupational therapists and their assistants play in improving the lives of people who need assistance to regain physical, social and cognitive abilities.

Occupational Therapy (OT) was first recognized as a profession in the year 1917, with the founding of the Society for the Promotion of Occupational Therapy. Currently known as the American Occupational Therapy Association (AOTA), this organization certifies and accredits all practicing occupational therapists (OTs) in the United States. There are more than 100,000 OTs currently working across the country in a variety of settings such as hospitals, outpatient rehabilitation centers, home healthcare agencies, assisted living centers and clinics, schools and specialty healthcare centers.

OT is a set of specialized assessments, treatments and strategies designed to enable people of all ages to do their routine activities of life in a better manner. Occupational therapists develop a client-centered approach focusing on patients’ needs and ability and modify environments to build up skill and independence to help them achieve their goals.

By following a holistic approach to therapeutic care, OTs help disabled children, adults, seniors and other people suffering from traumatic injuries or illness to perform their activities more independently. They promote and support exercise and physical activity programs that encourage people to carry out their routine activities and maintain or improve their health and wellbeing. The event is celebrated in hospitals and healthcare agencies across the country by hosting a series of events such as seminars, presentations, contests, health fairs and other contests to highlight the role of OTs in enhancing the wellbeing of patients from all walks of life.

Occupational Therapy – What it Involves

As an initial step, an occupational therapist may assess the individual needs of patients by identifying their areas of deficiency. This is done by performing physical tests, asking a number of questions about what the patient cares most and even examining the patient’s environment. After conducting a thorough assessment, these specialists will create a specific plan to address the individual needs of patients and recommend a set of strategies to help them achieve their goals. In addition, a periodic reassessment will be done to monitor progress on an ongoing basis and the required modifications will be made in order to maximize the benefits to the patient.

Medicare Coverage for Occupational Therapy

Medicare pays for OT services whether the patient needs it on a temporary basis to restore his/her condition, or needs it on an ongoing basis to prevent the particular condition from getting worse. These services can be availed as an outpatient in a participating hospital or skilled nursing facility, home health agency, rehabilitation agency, Comprehensive Outpatient Rehabilitation Facility (CORF) or public health agency.

Medicare will cover outpatient OT services if –

  • Patients need therapy and it is considered a safe and effective treatment for them
  • Physicians or therapist sets up the treatment plan before the patient receives care
  • Physicians or therapists regularly review the treatment plan to determine whether any specific changes are required

However, Medicare limits how much it pays for medically necessary outpatient therapy services in one calendar year and these limits are commonly referred to as “therapy caps”. The therapy cap limits for 2015 are –

  • $1,940 for occupational therapy (OT) services

In addition, patients may qualify to get an exception to therapy cap limits. In such cases, Medicare will continue to pay its share for the services after the patient reaches the limits. If patients are approaching the limit and the physician or therapist feels that they require more treatment, they can indicate that the additional treatment is medically reasonable and necessary. With proper documentation from the provider, Medicare may cover additional treatment required.

Physicians or therapists must correctly document their diagnosis and the services they perform in order to help coders assign the correct diagnostic and procedural codes during the medical coding process. Unnecessary medical claim delays due to incorrect coding can be avoided if the coding tasks are assigned to qualified and experienced coders. Assigning the coding tasks to a reliable and professional medical billing and coding company will enable physicians to benefit from timely claims submission and accurate reimbursement.

The following CPT codes are used for occupational therapy.

  • 97003 – Occupational therapy evaluation
  • 97004 – Occupational therapy reevaluation

Providers can use the following HCPCS codes for medical billing purposes –

  • G0129 – Occupational therapy requiring the skills of a qualified occupational therapist, furnished as a component of a partial hospitalization treatment program, per session (45 minutes or more)
  • G0152 – Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes
  • G0158 – Services performed by qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes
  • G0160 – Services performed by a qualified occupational therapist in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes
  • S9129 – Occupational therapy, in the home, per diem

Let Us Join Hands in Celebrating Occupational Therapy Month

Join this celebration and recognize the talent and efforts of OTs and assistants who help others “Live Life to its Fullest.”