OHCA Policies and Rules

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Part       OCCUPATIONAL THERAPY SERVICES

317:30⊂chapter=5∂=28--295.Eligible Providers
[Issued 08-01-07]
(a) Eligible occupational therapists must be appropriately licensed in the state in which they practice.
(b) All eligible providers of occupational therapy services must have entered into a Provider Agreement with the Oklahoma Health Care Authority to perform occupational therapy services.

317:30⊂chapter=5∂=28--296.Coverage by category
[Revised 01-14-13]
Payment is made for occupational therapy services as set forth in this Section.
(1) Children. Initial therapy evaluations do not require prior authorization. All therapy services following the initial evaluation must be prior authorized for continuation of service. Prior to the initial evaluation, the therapist must have on file a signed and dated prescription or referral for the therapy services from the member's physician or other licensed practitioner of the healing arts. The prescribing or referring provider must be able to provide, if requested, clinical documentation from the member's medical record that supports the medical necessity for the evaluation and referral.
(2) Adults. There is no coverage for adults for services rendered by individually contracted providers. Coverage for adults is permitted in an outpatient hospital setting as described in 30-5-42.1.
(3) Individuals eligible for Part B of Medicare. Services provided to Medicare eligible recipients are filed directly with the fiscal agent.
317:30⊂chapter=5∂=28--297.Payment rates
[Issued 08-01-07]
Payment is made in accordance with the current allowable Medicaid fee schedule.

317:30⊂chapter=5∂=28--298.Procedure codes
[Issued 08-01-07]
The appropriate procedure codes used for billing occupational therapy services are found in the Physicians' Current Procedural Terminology (CPT) Coding Manual.

317:30⊂chapter=5∂=28--299.Team therapy (Co-treatment)
[Issued 08-13-10]
Therapists, or therapy assistants, working together as a team to treat one or more members cannot each bill separately for the same or different service provided at the same time to the same member.
(1) CPT codes are used for billing the services of one therapist or therapy assistant. The therapist cannot bill for his/her services and those of another therapist or a therapy assistant, when both provide the same or different services, at the same time, to the same member.
(2) If multiple therapies (physical therapy, occupational therapy, and/or speech therapy) are provided to one member at the same time, only one therapist can bill for the entire service, or each therapist can divide the service units.
(3) Providers must report the CPT code for the time actually spent in the delivery of the modality requiring constant attendance and therapy services. Pre- and post-delivery services are not to be counted in determining the treatment service time. The time counted must begin when the therapist is directly working with the member to deliver treatment services.
(4) The time counted is the time the member is being treated. If the member requires both a therapist and an assistant, or even two therapists, each service unit of time the member is being treated can count as only one unit of each code. The service units billed must equal the total time the member was receiving actual therapy services. It is not allowable for each therapist or therapy assistant to bill for the entire therapy session. The time the member spends not being treated, for any reason, must not be billed.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.