Page 218 - Medicare Benefit Policy Manual

• graduated from an OT education program accredited as substantially equivalent to
a U.S. OT education program by ACOTE, the World Federation of Occupational
Therapists, or a credentialing body approved by AOTA; and

• passed the NBCOT examination for OT; and

• Effective January 1, 2010, are licensed or otherwise regulated, if applicable as an
OT by the state in which practicing.

For outpatient OT services that are provided incident to the services of physicians/NPPs,
the requirement for OT licensure does not apply; all other personnel qualifications do
apply. The qualified personnel providing OT services incident to the services of a
physician/NPP must be trained in an accredited OT curriculum. For example, a person
who, on or before December 31, 2009, graduated from an OT curriculum accredited by
ACOTE and is eligible to take or has successfully completed the entry-level certification
examination for OTs developed and administered by NBCOT, could provide Medicare
outpatient OT services incident to the services of a physician/NPP if the physician
assumes responsibility for the services according to the incident to policies. On or after
January 1, 2010, although licensure does not apply, both education and examination
requirements that are effective January 1, 2010, apply to qualified personnel who provide
OT services incident to the services of a physician/NPP.

C. Services of Occupational Therapy Support Personnel

Reference: 42CFR 484.4

The new personnel qualifications for occupational therapy assistants were discussed in
the 2008 Physician Fee Schedule. See the Federal Register of November 27, 2007, for
the full text. See also the correction notice for this rule, published in the Federal Register
on January 15, 2008.

The regulation provides that an occupational therapy assistant is a person who is licensed,
unless licensure does not apply, or otherwise regulated, if applicable, as an OTA by the
state in which practicing, and graduated from an OTA education program accredited by
ACOTE and is eligible to take or has successfully completed the NBCOT examination
for OTAs. The phrase, “by the state in which practicing” includes any authorization to
practice provided by the same state in which the service is provided, including temporary
licensure, regardless of the location of the entity billing the services.

If the requirements above are not met, an OTA may qualify if, on or before December 31,
2009, the OTA is licensed or otherwise regulated as an OTA, if applicable, by the state in
which practicing, or meets any qualifications defined by the state in which practicing.

Or, where licensure or other state regulation does not apply, OTAs may qualify if they
have, on or before December 31, 2009: