Service Description

Service Description: Occupational therapy includes services to address the functional needs of a child related to adaptive development; adaptive behavior, restoration, and play; and sensory, motor, and postural development. These services are designed to improve the child's functional ability to perform tasks in home, school, and community settings and include:

  1. Evaluation, assessment, and intervention; (global evaluation not acceptable)
  2. Adaptation of the environment and selection, design and fabrication of assistive and orthotic devices to facilitate development and promote the acquisition of functional skills; and
  3. Prevention or minimization of the impact of initial or future impairment, delay in development, or loss of functional ability.

Activities also include IFSP development, assistive technology assessment if needed, and environmental consultation to ensure that appropriate adaptations and safety issues for the eligible child are incorporated.

Family training, education and support provided to assist the family of a child eligible for services in understanding the special needs of the child as related to occupational therapy services and enhancing the child's development are integral to this service. Eligible child is not required to be present but may be if appropriate. May include such services as support groups, individual support and other training or education for the family.

Services must be consistent with the provider's qualifications and licensure.

NOTE: Early Intervention does not pay for therapeutic services required due to, or as part of, a medical procedure, a medical intervention or an injury. Acute rehabilitative therapy and therapy required as part of a medical procedure, medical intervention or injury, is not developmentally based but is medically based. Once the condition has become chronic or sub-acute the therapy for the on-going developmental delay can be provided by EI.

Qualified Staff: 1) System enrolled Specialist credentialed as a Licensed Occupational Therapist or 2) a non-enrolled Associate credentialed as a Licensed Certified Occupational Therapy Assistant. Assistants must work under the supervision of an enrolled Licensed Occupational Therapist. (See ATTACHMENT 4: USE OF ASSOCIATE LEVEL PROVIDERS for more detail. See ATTACHMENT 5: REQUIREMENTS FOR PROFESSIONAL AND ASSOCIATE LEVEL EARLY INTERVENTION CREDENTIALING AND ENROLLMENT TO BILL.)

Billable Activities Evaluation / assessment, IFSP development, (see DEFINITIONS section for With Authorization: IFSP development definition) and direct services.

NOTE: Bill for time required to develop assistive technology requests using IFSP development code.

Do not provide services without having an authorization in hand. Services provided without a pre-approved authorization are not guaranteed for payment.

Occupational Therapy

Procedure Codes Modifiers Unit of Service Description Rate
97003 15 minutes Evaluation/Assessment - onsite $14.11
97003 15 minutes Evaluation/Assessment - offsite $17.61
99271 SC 15 minutes IFSP development $14.11
99271 SC 15 minutes IFSP meeting $17.61
97530 15 minutes Individual therapy - onsite $14.11
97530 15 minutes Individual therapy - offsite $17.61
97150 SC 15 minutes Group therapy (multiple families or group not to exceed 4 children) $ 7.65