Outpatient Occupational Therapy

Outpatient occupational therapy is covered when provided by or under the supervision of a qualified, licensed OT and when services are reasonable, necessary, and documented in a physician/NPP-approved plan of care with specific goals, type, frequency and duration. Coverage includes restorative and, when skilled need is present, maintenance therapy and a wide range of modalities and procedures (e.g., splints/casts, biofeedback, swallowing evaluation/therapy, traction, vasopneumatic devices, contrast baths, ultrasound, iontophoresis), while routine nursing care, non-skilled maintenance, and certain modality uses (e.g., TENS for chronic low back pain, ultrasound for pulmonary conditions) are excluded. Documentation of objective, measurable functional limitations, justification for comprehensive testing, provider licensure, and appropriate supervision are required; some education/training services (e.g., vasopneumatic device training) are generally limited to about three visits.