N.Y. Comp. Codes R. & Regs. tit. 10 § 447.5
Current through Register Vol. 46, No. 50, December 11, 2024
Section 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 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 facility, 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 |
Code number* | Service category | 1 pt. | 2-4 pts. | 5-8 pts. | 9 or more pts. |
| (b) Occupational Therapy Assessment. | | | | |
| (1) Screening | 11 | 5.5 | 3.3 | |
98004 | (2) Patient Related Consultation | 14 | | | |
| (3) Evaluation | | | | |
98055-06 | (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 motional 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 |
| (c) Gross and Fine Coordination | 13 | 6.5 | 3.9 | 1.3 |
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 | | | | |
96110-13 | (i) Self Management | 14 | 7.0 | 4.2 | 1.4 |
96115-16 | (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 Equipment | 16 | 8.0 | | |
98140-43 | (6) Prevention | 13 | 6.5 | 3.9 | 1.3 |
98145 | (d) Patient/Client-Related Conferences | 14 | | | |
98150-53 | (e) Travel: Patient Treatment-Related | 12 | 6.0 | 3.6 | 1.2 |
(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.N.Y. Comp. Codes R. & Regs. Tit. 10 § 447.5