CMS Pub. 100-02, ch. 7, § 40.2.4.2

Programs

(Rev. 1, 10-01-03)

A3-3118.2.D.2, HHA-205.2.D.2

The planning, implementing, and supervision of therapeutic programs including, but not

limited to those listed below are skilled occupational therapy services, and if reasonable

and necessary to the treatment of the patient's illness or injury would be covered.

A. Selecting and Teaching Task Oriented Therapeutic Activities Designed to

Restore Physical Function.

EXAMPLE: Use of woodworking activities on an inclined table to restore shoulder,

elbow, and wrist range of motion lost as a result of burns.

B. Planning, Implementing, and Supervising Therapeutic Tasks and Activities

Designed to Restore Sensory-Integrative Function.

EXAMPLE: Providing motor and tactile activities to increase sensory output and

improve response for a stroke patient with functional loss resulting in a distorted body

image.

C. Planning, Implementing, and Supervising of Individualized Therapeutic Activity

Programs as Part of an Overall "Active Treatment" Program for a Patient With a

Diagnosed Psychiatric Illness.

EXAMPLE: Use of sewing activities that require following a pattern to reduce

confusion and restore reality orientation in a schizophrenic patient.

D. Teaching Compensatory Techniques to Improve the Level of Independence in

the Activities of Daily Living.

EXAMPLE: Teaching a patient who has lost use of an arm how to pare potatoes and

chop vegetables with one hand.

EXAMPLE: Teaching a stroke patient new techniques to enable them to perform

feeding, dressing, and other activities of daily living as independently as possible.

E. The Designing, Fabricating, and Fitting of Orthotic and Self-Help Devices.

EXAMPLE: Construction of a device which would enable a patient to hold a utensil and

feed themselves independently.

EXAMPLE: Construction of a hand splint for a patient with rheumatoid arthritis to

maintain the hand in a functional position.

F. Vocational and Prevocational Assessment and Training

Vocational and prevocational assessment and training that is directed toward the

restoration of function in the activities of daily living lost due to illness or injury would

be covered. Where vocational or prevocational assessment and training is related solely

to specific employment opportunities, work skills, or work settings, such services would

not be covered because they would not be directed toward the treatment of an illness or

injury.