Occupational therapy provides treatment for people of all ages who are having difficulty performing necessary daily activities, either at home or work, due to injuries, disabilities or impairments, and mental health problems. It is also helpful for seniors who are experiencing physical or cognitive changes brought on by aging.
Occupational therapists work closely with their patients, first to assess the problem, and then to find a technique or procedure to use for optimum results. The aim of occupational therapy is to assist in recovery and development, and help patients overcome the challenges they face in carrying out their normal daily activities.
If you, or someone you are caring for, have a condition that interferes with normal day-to-day living, taking part in occupational therapy sessions may result in relief from discomfort and restore your independence.
Medicare Benefits and Costs of Occupational Therapy
For people who do not have insurance coverage, the cost of an occupational therapy session is between $150.00 and $200.00 for the initial evaluation, and between $40.00 and $200.00 for each therapy session. A session generally lasts for one hour. The hourly price you pay depends on the type of facility providing care, as well as what type of therapy you are getting.
For Medicare recipients, coverage for occupational therapy as an outpatient is covered through Part B. Medicare recipients who have Original Medicare Part B have coverage for several types of outpatient therapy which include occupational therapy, physical therapy, and speech-language therapy. In past years, Medicare had limits as to how much outpatient therapy they would pay for. As of 2019, the limits were removed.
Under Part B, Medicare will likely pay for 80 percent of the Medicare-approved amount for outpatient therapy. You are responsible for 20 percent of that cost as well as your Part B deductible which is $185.00 as of 2019. You are also required to receive your outpatient therapy from a provider that accepts Medicare assignment in order to be eligible for compensation.
You may receive outpatient occupational therapy sessions without confirmation of being medically necessary if the amount of therapy sessions does not exceed $2,040.00. If that amount is surpassed, you must obtain written confirmation of medical necessity for these occupational therapy sessions from your health care provider. This ensures that your Medicare benefits continue paying for your occupational therapy sessions.
Because your Medicare benefits cover 80 percent of the cost of therapy sessions, this means that the amount allowed by Medicare without medical necessity confirmation amounts to $1,608.00.
If you are enrolled in a Medicare Advantage plan, you will have at least the same coverage as Original Medicare Part A and Part B, but many plans offer additional benefits. Check with your plan for specific costs and coverage for occupational therapy.
How Does Occupational Therapy Work?
Your occupational therapy sessions may begin in your own home. A licensed occupational therapist assesses you and your living environment as you, and the people you live with, go about your normal daily activities.
The occupational therapist also asks questions and reviews your medical history. This way they can evaluate your condition and come up with the right treatment plan to meet your needs.
If you have trouble with movement because of a disability or arthritis, your occupational therapist may suggest specialized exercises. They also help you by educating the other family members in how to give care to suit your needs. An occupational therapist may also make recommendations for specialized equipment that may help with daily activities.
You may be a candidate for occupational therapy if you have, or have had one of the following conditions:
• Injuries that are work related
• Amputation or prosthetics
• A stroke
• A heart attack
• Multiple sclerosis
• A permanent disability
• A head injury
• Mental health problems
• Severe burns
• Spinal cord trauma
• A mental illness or an emotional disturbance
It is important to take advantage of occupational therapy when needed to improve and maintain vital skills, independence, and continued well-being.