Page 216 - Medicare Benefit Policy Manual

• The 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; e.g., the use of sewing activities which
require following a pattern to reduce confusion and restore reality orientation in a
schizophrenic patient;

• The planning and implementing of therapeutic tasks and activities to restore
sensory-integrative function; e.g., providing motor and tactile activities to
increase sensory input and improve response for a stroke patient with functional
loss resulting in a distorted body image;

• The teaching of compensatory technique to improve the level of independence in
the activities of daily living or adapt to an evolving deterioration in health and
function, for example:

o Teaching a patient who has lost the use of an arm how to pare potatoes
and chop vegetables with one hand;

o Teaching an upper extremity amputee how to functionally utilize a
prosthesis;

o Teaching a stroke patient new techniques to enable the patient to perform
feeding, dressing, and other activities as independently as possible; or

o Teaching a patient with a hip fracture/hip replacement techniques of
standing tolerance and balance to enable the patient to perform such
functional activities as dressing and homemaking tasks.

• The designing, fabricating, and fitting of orthotics and self-help devices; e.g.,
making a hand splint for a patient with rheumatoid arthritis to maintain the
hand in a functional position or constructing a device which would enable an
individual to hold a utensil and feed independently; or

• Vocational and prevocational assessment and training, subject to the
limitations specified in item B below.

Only a qualified occupational therapist has the knowledge, training, and experience
required to evaluate and, as necessary, 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, recommend to the physician/NPP a plan of
treatment, where appropriate.

B. Qualified Occupational Therapist Defined
Reference: 42CFR484.4