Occupational Therapy

(a)Occupational therapy when medically necessary is covered; provided, that the therapy must be to restore a bodily function that once existed, or has been lost or damaged due to disease or accidental injury. Coverage is only to the extent that it restores function to the status of function prior to the disease or accidental injury. CH. 2 DIVISION OF PUBLIC WELFARE

(1)Therapy must result in significant and demonstrable improvements in the patient’s ability to function independently.

(2)Benefit is limited to treatments by an occupational therapist.

(3)The first twenty

(20)visits are covered in full.

(4)A fifty percent (50%) co-insurance is required for all subsequent treatments meeting the criteria set forth in subsection

(a)above.

(b)Services Not Covered. The following are not covered under the occupational therapy benefit:

(1)services determined not to result in significant and demonstrable improvements in the patient’s ability to function independently.

(c)Limitations and Exclusions. All occupational therapy services are subject to the stated benefit limitations and exclusions outlined in § 2912 through § 2913.