Does Medicare Cover Occupational Therapy?
Short answer
Yes. Medicare Part B covers medically necessary outpatient occupational therapy when an eligible health care provider certifies that you need it. Occupational therapy can help you improve or maintain the ability to perform everyday activities or slow a decline in those abilities.
What occupational therapy does
Occupational therapy focuses on functional activities such as dressing, bathing and other daily tasks. Treatment may involve evaluation, therapeutic activities, adaptive techniques or other skilled interventions appropriate to the condition and treatment plan.
Coverage does not require improvement in every case
Medicare’s coverage is not limited to therapy expected to restore you completely. Skilled occupational therapy can be medically necessary to maintain your current capabilities or slow functional decline when the clinical record supports the need for skilled care.
Certification and ongoing medical necessity
A doctor or other eligible health care provider must certify the need for outpatient OT. Each service must remain reasonable and necessary. Routine assistance with daily activities by itself is not transformed into a Medicare-covered skilled therapy service simply because the activity resembles something practiced during OT.
Costs and annual limits
Original Medicare Part B deductible and coinsurance rules generally apply. Medicare does not impose a fixed annual dollar cap on medically necessary outpatient therapy, although documentation and review requirements can apply as therapy expenses increase.
Medicare Advantage
Medicare Advantage plans cover Medicare-covered occupational therapy but can use plan networks, authorization and different cost sharing. Check the current plan rules and therapy provider network.