|
24.5.10 Occupational Therapy (OT) Services
As stated in the TAC, to be payable as a Home Health Services benefit, OT services must be:
• Requested for a payable ICD-9-CM diagnosis code.
•Provided by an occupational therapist or an occupational therapy assistant who is currently registered and licensed by the Executive Council of Physical Therapy and Occupational Therapy Examiners. An occupational therapy assistant must be supervised by a licensed occupational therapist.
•For the treatment of an acute musculoskeletal or neuromuscular condition or an acute exacerbation of a chronic musculoskeletal or neuromuscular condition.
OT authorization must be requested by the home health agency's RN and recommended to be done after the RN assessment. Requests are not accepted, nor authorization granted, directly to the occupational therapist or OT assistant.
•For the evaluation and function-oriented treatment of individuals whose ability to function in life roles is impaired by recent or current physical illness, injury, or condition.
•For specific goal-directed activities to achieve a functional level of mobility and communication and prevent further dysfunction within a reasonable length of time based on the therapist's evaluation and physician's assessment and POC.
•Provided only until the client has reached the maximum level of improvement. Repetitive services designed to maintain function when the maximum level of improvement has been reached are not reimbursed. Services related to activities for the general good and welfare of clients, such as general exercises to promote overall fitness and flexibility, and activities to provide diversion or general motivation are not reimbursed.
Refer to: "Occupational Therapists (THSteps-CCP Only)" . Note: THSteps-eligible clients who qualify for medically necessary services beyond the limits of this Home Health Services benefit will receive those services through THSteps-CCP. Refer to: Section 24.3.1, "Eligibility."
|
