US · guidance
CMS Pub. 100-02, ch. 7, § 40.2.4
Application of the General Principles to Occupational Therapy
A3-3118.2.D, HHA-205.2.D
The following discussion of skilled occupational therapy services applies the principles to
specific occupational therapy services about which questions are most frequently raised.
Coverage of occupational therapy services is not determined solely on the presence or
absence of a beneficiary’s potential for improvement from the therapy, but rather on the
beneficiary’s need for skilled care. Assuming all other eligibility and coverage
requirements have been met, skilled occupational therapy services are covered when the
individualized assessment of the patient’s clinical condition demonstrates that the
specialized judgment, knowledge, and skills of a qualified occupational therapist are
necessary.
History
(Rev. 179, Issued: 01-14-14, Effective: 01-07-14, Implementation: 01-07-14)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
6b6c907e0cd0efd73f8b71a397db10fa916047320a59ae370e54f3e0e4b8ee6f
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