Section 7 AAC 115.110 - Occupational therapy services(a) The department will pay for occupational therapy services and supplies (1) that are identified in the Fee Schedule for Therapy Services, adopted by reference in 7 AAC 160.900; and(2) if those services, except the initial evaluation, are (A) prescribed by a physician, an advanced practice registered nurse, a physician assistant, or another licensed health care professional, within the scope of the practitioner's license;(B) within the scope of practice of an occupational therapist or occupational therapy assistant;(C) provided by or under the direction of an occupational therapist who is enrolled under 7 AAC 105 - 7 AAC 160;(D) provided in accordance with the initial evaluation conducted under 7 AAC 115.120(a) and treatment plan developed by the occupational therapist under 7 AAC 115.120(b); and(E) documented in a progress note to include start and stop times for time-based billing codes used as provided in the Healthcare Common Procedure Coding System (HCPCS), adopted by reference in 7 AAC 160.900.(b) The department will not pay for occupational therapy services for an individual 21 years of age or older that are for maintenance of bodily function, swimming therapy, or weight loss.(c) The department will not pay for the services provided by an occupational therapist aide.(d) The department will pay for maintenance occupational therapy services related to conditions caused by developmental disabilities or developmental delay provided to a recipient under 21 years of age if the services prevent a condition from worsening or the development of an additional health problem.(e) An occupational therapy provider enrolled under this section may request payment for select medically necessary durable medical equipment, medical supplies, prefabricated off-the-shelf orthotics, or related items and services under 7 AAC 120.200(a)(2) listed on the Fee Schedule for Therapy Services, adopted by reference in 7 AAC 160.900, if the item is furnished to a recipient and dispensed by the occupational therapist in the standard course of therapy within the scope of that professional's license.(f) For an individual 21 years of age or older, the department will pay for (1) two units of physical and occupational therapy evaluation services combined each state fiscal year;(2) 30 units of physical and occupational therapy services combined each state fiscal year; and(3) additional units of occupational therapy services if the department gives prior authorization based upon medical justification submitted by the provider.Eff. 2/1/20150, Register 193; am 9/1/2017, Register 223, October 2017; am 6/2/2019, Register 230, May 2019; am 3/3/2023, Register 245, April 2023Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040