Section 447.5 - Occupational Therapy Services

447.5 Occupational therapy services.
(a) ACCOUNT NUMBER COST CENTER TITLE
7530 Occupational Therapy
(1) The standard unit of measure will be the relative value units developed by the American Occupational Therapy Association. Relative value units should be counted during a patient visit for all assessment, treatment or other activities which use the resources of the occupational therapy department, and for which a charge is made. Fifteen minutes is the smallest increment of time for which a unit of service should occur. After the initial 15 minutes, patient contact for less than 15 minutes should be rounded to the nearest whole 15-minute period.
(2) For patient groups of two or more, the appropriate relative value units listed in the schedule should be counted for each patient in the group. Different codes should be used to indicate the same treatment given to different size groups.
(3) Since a charge for only one treatment for a 15-minute period can be made, concurrent or combination treatments should be handled by selecting the most significant or longest treatment determined by the therapist.
(4) Occupational therapy services provided in the home will have a unit value equivalent to that shown in the schedule for the service provided, plus the applicable unit value for travel time to and from the home.
(5) Relative value units for unlisted procedures should be reasonably estimated on the basis of other comparable procedures, or estimated by qualified personnel. If your facility has a standard set of treatments that all patients receive unique to your facililty, using the system as a guide, relative value units should be developed.
(6) The system includes several definitions of activities not listed on the Relative Value Schedule, as the schedule is designed only for direct treatment.
RVU's per 15
minutes Patient Group
Categories

9 or
Code 1 2-4 5-8 more
number* Service category pt. pts. pts. pts.

(b) Occupational Therapy Assessment.

98001-03 (1) Screening 11 5.5 3.3

98004 (2) Patient Related Consultation 14

(3) Evaluation

98005-06 (i) Independent Living/Daily
Living Skills and
Performance 18 9.0

98010-00 (ii) Sensorimotor Skill and
Performance Components 21 10.5

98015-16 (iii) Cognitive Skill and Performance
Components 20 10.0

98020-21 (iv) Psychosocial Skill and
Performance Components 18 9.0

98025-26 (v) Therapeutic Adaptations 19

98030-32 (vi) Specialized Evaluation 23 11.5 6.9

(4) Reassessment 18 9.0

(c) Occupational Therapy Treatment.

(1) Independent Living/Daily Living
Skills and Performance

98040-42 (i) Physical Daily Living Skills 13 6.5 3.9

98045-47 (ii) Psychosocial/Emotional Daily
Living Skills 13 6.5 3.9

(iii) Work

98050-52 (a) Homemaking 15 7.5 4.5

98055-57 (b) Child Care/Parenting 18 9.0 5.4

98060-62 (c) Employment Preparation 19 9.5 5.7

98065-67 (iv) Play/Leisure 14 7.0 4.2

(2) Sensorimotor Components

(i) Neuromuscular

98070 (a) Reflex Integration 18

98075-78 (b) Range of Motion 13 6.5 3.9 1.3

98080-83 (c) Gross and Fine 13 6.5 3.9 1.3
Coordination

98085-88 (d) Strength and Endurance 13 6.5 3.9 1.3

98090-92 (ii) Sensory Integration 16 8.0 4.8

(3) Cognitive Components

98095-98 (i) Orientation 10 5.0 3.0 1.0

98100-01 (ii) Conceptualization/Comprehension 14 7.0

98105-06 (iii) Cognitive Integration 14 7.0

(4) Psychosocial Components

98110-13 (i) Self Management 14 7.0 4.2 1.4

98115-16 (ii) Dyadic Interaction 14 7.0

98120-23 (iii) Group Interaction 10 5.0 3.0 1.0

(5) Therapeutic Adaptation

98125 (i) Orthotics 20

98130-31 (ii) Prosthetics 16 8.0

98135-36 (iii) Assistive/Adaptive 16 8.0

98140-43 (6) Prevention 13 6.5 3.9 1.3

98145 (d) Patient/Client-Related 14
Conferences

98150-53 (e) Travel: Patient 12 6.0 3.6 1.2
Treatment Related
(f) Only one code number may be used for a given category. Thus, where a series of code numbers are listed, each code number in the series is to be used for a different patient group category. For example, code numbers 98001 through 98003 are given for screening: 98001 would be used for screening one patient, 98002 for screening a group of two to five patients, and 98003 for screening a group of six to eight patients.

 

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