Home Health Occupational Therapy
Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §40.2.4)
Visits by an occupational therapist to assess and reassess a beneficiary's rehabilitation needs and potential, or to develop and/or implement an occupational therapy program, are covered when reasonable and necessary because of the beneficiary's condition.
It should be clear in the documentation that the occupational therapist is working on functional limitations and tasks with the beneficiary.
New requirements were mandated in the Calendar Year 2013 Final Rulefor therapy services provided in the home health setting for episodes beginning on or after January 1, 2013. In addition, the Centers for Medicare & Medicaid Services (CMS) published FAQson this topic.
- Four Principles for Medical Necessity of Therapy— Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §40.2.1)
- Medicare Learning Network (MLN) Matters® article MM7374, "Manual Changes for Therapy Services in Home Health, Publication 100-02, Chapter 7"
- MLN Matters® article MM8036, "Manual Medical Review of Therapy Services"
- Documenting Medical Necessity of Occupational Therapy
- When Occupational and Physical Therapist Both Provide Services
Updated: 06.26.13
Reviewed: 12.10.21