1. (a) Reimbursement for occupational therapy services shall be the usual charges made to the general public not to exceed the maximum reimbursement rates listed in this section.

2. (b) The following definitions shall apply to the reimbursement of occupational services under this section:

   1. (1) Treatment means therapeutic procedures which require the personal attention or direct supervision of the therapist.
   2. (2) Evaluation means initial or subsequent evaluation using tests, measurements, and observation of the patient's performance, progress, and behavior, and includes written reports thereof.
   3. (3) Case conference means participation in organized conference with other health team members, who are immediately involved in the care or recovery of the patient, concerning status or progress of the patient under treatment and includes required charting entries. Case conferences shall be limited to one per patient per month.
   4. (4) Additional 15-minute periods means any 15-minute period or a major portion thereof, 7 minutes or more, following the initial 30-minute period.
   5. (5) The maximum allowance for home or long-term care facility visit is payable only for visits to the first patient receiving services at any given location on the same day.

3. (c) The maximum reimbursement rates for occupational therapy services shall be as follows:

   Procedure Code

   Maximum Allowance

   X4100

   Evaluation--initial 30 minutes, plus report

   $34.84

   X4102

   Evaluation--each additional 15 minutes, plus report

   17.04

   X4104

   Case conference and report--initial 30 minutes

   21.19

   X4106

   Case conference and report--each additional 15 minutes

   6.86

   X4120

   Case consultation and report

   21.19

   X4108

   Occupational therapy preliminary evaluation in a rehabilitation center, SNF, ICF, or subacute care facility

   34.84

   X4110

   Treatment--initial 30 minutes

   21.19

   X4112

   Treatment--each additional 15 minutes

   6.86

   X4114

   Home or long-term care facility visit--add

   6.57

   X4116

   Mileage per mile, one way, beyond a ten-mile radius of office or usual hospital base

   1.77

   X4118

   Unlisted services

   By Report

Note: Authority cited: Sections 10725, 14105 and 14124.5, Welfare and Institutions Code. Reference: Section 14105, Welfare and Institutions Code; Statutes of 1984, Chapter 258, Items 4260-106-001 and 890; Statutes of 1985, Chapter 111, Items 4260-106-001 and 890; and Statutes of 2000, Chapter 52, Items 4260-101-0001 and 0890.

History

1. Amendment of subsection (c) filed 8-1-84 as an emergency; effective upon filing (Register 84, No. 31). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-84. For prior history, see Register 81, No. 52.

2. Certificate of Compliance transmitted to OAL 11-27-84 and filed 12-27-84 (Register 84, No. 52).

3. Amendment of subsection (c) filed 8-1-85 as an emergency; effective on filing (Register 85, No. 32). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-85.

4. Certificate of Compliance transmitted to OAL 11-20-85 and filed 12-27-85 (Register 85, No. 52).

5. Amendment of subsection (c) filed 9-25-92 as an emergency; operative 10-1-92 (Register 92, No. 40). A Certificate of Compliance must be transmitted to OAL 1-25-93 or emergency language will be repealed by operation of law on the following day.

6. Amendment of subsection (c) adding X4120 filed 8-2-95 as an emergency; operative 8-2-95 (Register 95, No. 31). A Certificate of Compliance must be transmitted to OAL by 11-30-95 or emergency language will be repealed by operation of law on the following day.

7. Certificate of Compliance as to 8-2-95 order transmitted to OAL 11-22-95 and filed 1-3-96 (Register 96, No. 1).

8. Amendment of subsection (c), new subsection (d) and amendment of Note filed 7-16-2002; operative rates for services provided on or after 8-1-2000 pursuant to Stats. 2000, c. 52, Items 4260-101-0001 and 0890 (Register 2002, No. 29).

9. Certificate of Compliance as to 7-16-2002 order, including repealer of subsection (d), transmitted to OAL 11-12-2002 and filed 12-24-2002 (Register 2002, No. 52).