Medicare Benefit Policy Manual (Pub. 100-02), Ch. 12 § 40.3
Occupational Therapy Services
40.3 - Occupational Therapy Services
(Rev. 111, Issued: 09-25-09; Effective Date: 07-07-08; Implementation Date: 10-26-
09)
Occupational therapy is a medically prescribed treatment to improve or restore functions
that have been impaired by illness or injury or, when function has been permanently lost
or reduced by illness or injury, to improve the individual's ability to perform those tasks
required for independent functioning. Occupational therapy services are covered CORF
services if physical therapy services are the predominate rehabilitation services provided
in the CORF.
A qualified occupational therapist, as defined at 42CFR485.70(c), has the knowledge,
training, and experience required to evaluate and reevaluate a patient's level of function,
determine whether an occupational therapy program could reasonably be expected to
improve, restore, or compensate for lost function, and recommend to the physician a plan
of treatment. The skills of a qualified occupational therapist are required to evaluate and
reevaluate the patient's level of function and to develop, in consultation with the
physician as appropriate, the occupational therapy plan of treatment. A qualified
occupational therapy assistant, as defined at 42CFR485.70(c), functioning under the
supervision of the qualified occupational therapist may also carry out various aspects, as
appropriate, of the occupational therapy plan of treatment, in accordance with applicable
State laws. Occupational therapist assistants are not allowed to conduct the discharge
visit as this visit is viewed as the final assessment of the patient’s progress toward
attaining the goals of the occupational therapy plan of treatment.
NOTE: Supervision of CORF occupational therapy services requires that the
occupational therapist either must be on the premises of the CORF or must be available
to the occupational therapy assistant through direct telecommunications for consultation
and assistance during the CORF’s operating hours. (See 42CFR485.58(d)(6)).