I am in the process of trying to determine why the FI denied services for
OT, PT & Speech.  The comment was "usage guidelines not met".  So I went to
the most recent CMS Pub 100-02 Medicare Benefit Policy Transmittal 34.
This transmittal is effective June 6, 2005.

I was totally surprised to read the examples regarding the practice of
Occupational Therapy:

   The selection and teaching of task-oriented therapeutic activities
   designed to restore physical function; e.g. use of woodworking
   activities on an inclined table to restore shoulder, elbow and wrist
   range of motion lost as a result of burns;
   Teaching a patient with a hip fracture/hip replacement techniques of
   standing tolerance and balance to enable the patient to perform such
   functional activities as dressing and homemaking tasks.


Then it went on to state that a qualified occupational therapist is defined
as "eligible for the National Registration Examination of the American
Occupational Therapy Association".

Several questions came to mind after reading this and sharing this
information with a fellow OT.  How old is the definition of our services
use by Medicare?  Do the FI's really base their decision on these
descriptors?  Am I the only one who thinks these examples are out dated and
the eligible for exam is incorrect?

Dudi Wittwer, O.T.R.
Manager, Rehab Services
Bay Area Hospital
1775 Thompson Road
Coos Bay, Oregon 97420
[EMAIL PROTECTED]
(541) 269-8003


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