Does Medicare Cover Occupational Therapy?

Published by: Medicare Made Clear

For adults ages 65 and older, occupational therapy (OT) may benefit overall health and well-being after an illness, injury, or when dealing with a chronic health condition. Occupational therapy is often confused with physical therapy, and while they both are outpatient therapy services, they have different areas of focus. Occupational therapists are uniquely trained to help people at all stages of life with developing, maintaining, or recovering the physical skills needed to perform everyday activities and tasks.

 

Occupational therapy can also be especially helpful for those who experience physical or cognitive changes brought on by aging. In most cases, occupational therapy and other forms of outpatient therapy will have partial coverage under Medicare Part B.

 

 

What Occupational Therapy Services Does Medicare Cover?

 

Medicare Part B will help pay for occupational therapy services if (1) they are medically necessary, (2) your doctor or other healthcare provider certifies you need them, and (3) they are delivered in an outpatient setting. If you have a Medicare Advantage plan, you may get additional coverage for occupational therapy, but it will depend on the plan and provider you have.

 

The specific occupational therapy services you may need will vary based on your personal health and lifestyle needs.

 

Some examples of the therapeutic services an occupational therapist may provide:

 

  • Exercises and rehabilitation techniques to help with dressing, bathing, and eating

  • Help patients improve basic and fine motor skills, physical strength, and range of motion

  • Fall prevention (OTs can teach methods to help patients prevent falls, including working on balance and muscle-building exercises)

  • Cognitive exercises to aid in memory rehabilitation 

  • Recommendations for modifications to a patient’s living situation to aid in improved quality of life (e.g., handrails in the shower or a wheelchair ramp)

  • Activities to help improve perceptual vision, pattern detection, and visual awareness

  • A care plan for a patient’s caregiver to help provide support, encouragement, and guidance

 

 

What Will Medicare Pay for Occupational Therapy?

 

Generally, Medicare Part B will pay 80 percent of the Medicare-approved amount for occupational therapy services if you meet the requirements mentioned above (medically necessary, your doctor certifies the services are needed, and services are provided in an outpatient setting). If you have a Medicare Advantage plan, your coverage and costs may be different. You can check with the plan provider to learn more. For the 80 percent Part B coverage amount to be applied, the occupational therapy provider must also accept Medicare assignment.

 

There is no limit on how much Medicare will pay for medically necessary occupational therapy services in a calendar year.

 

 

What if My Doctor Recommends Other Occupational Therapy Services?

 

If your doctor or healthcare provider recommends other occupational therapy services that are not medically necessary, or if the occupational therapist provides additional services, Medicare may not cover them. If this happens, you may have to pay some or all the costs. Again, it depends on your Medicare coverage. A Medicare Advantage plan may offer more coverage.

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Who Should Consider Occupational Therapy?

 

There are a variety of reasons that someone may begin occupational therapy sessions, by choice or by referral. Usually, someone is referred to an occupational therapist because they need help recovering from a major medical event that has caused them to lose some skills needed in their daily life.

 

Other reasons someone may see an occupational therapist may include but are not limited to:

 

  • Aging

  • Amputation or prosthetics

  • Arthritis

  • Cognitive decline (e.g., dementia) 

  • Head injuries

  • Heart attack

  • Injuries that are work-related

  • Mental health problems/mental illness 

  • Multiple sclerosis

  • Permanent disability

  • Severe burns

  • Spinal cord trauma

  • Stroke

 

Someone who needs occupational therapy may also need or benefit from physical therapy or speech-language therapy services, which Medicare also provides coverage for.

 

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