Medicare and Occupational Therapy - What services are covered at home?

This is such a tricky topic, but read through and you will get a better understanding, I promise!

First of all, there are big differences between home health OT and outpatient OT at home. An at-home occupational therapist, such as Safe Optimal Spaces, will bill to Medicare part B, which is considered an outpatient service and "non-medical". Home health OT, is billed to Medicare part A and considered to be "medical" due to the acute nature of injuries, is provided through a home health care agency. Medicare part A is used when a person is more medically compromised, and part B is used when a person is more medically stable.

Under Medicare part B, outpatient OT must be medically necessary, which means a client needs to have an active diagnosis that is causing some deficits in day-to-day functioning. Medicare part A and B cannot be used at the same time for reimbursement. Wellness and/or preventative care are NOT covered under Medicare part B. The good news is that a client does not need to be "homebound", the client's billing diagnosis can be chronic in nature, which is not the case with home health OT covered under Medicare part A.

Check out the comparison below that I distribute to my clients:

Overview of Medicare Coverage

This table shows what Medicare Part B covers and does not cover for Occupational Therapy (OT) services provided in the patient’s home.

Covered

- OT evaluation linked to a medical diagnosis and functional problems.

- Home safety assessment when part of a medically necessary OT evaluation or treatment plan.

- ADL/IADL training that requires skilled OT due to a medical condition.

- Therapeutic exercise, balance training, and other skilled interventions.

- Cognitive‑functional training tied to a medical diagnosis.

- Caregiver training directly related to the patient’s medical and functional needs.

- Training on medically necessary DME.

- Re‑evaluations when medically necessary.

- Skilled OT for chronic conditions when functional deficits are present.

Not Covered

- Wellness or maintenance services without medical need.

- Stand‑alone home safety visits not tied to medical need.

- Non‑skilled help such as cleaning, cooking, or companionship.

- General fitness or exercise programs.

- Cognitive activities for general wellness or enrichment.

- Caregiver education not connected to skilled OT needs.

- Home modifications or installation work.

- Administrative check‑ins or non‑skilled visits.

- Services provided by non‑qualified personnel.

So, what do OT services look like at home when billed to Medicare part B?

• Learning safer ways to do tasks that have become difficult.

• We work on the activities that matter most to you.

• Improving memory, thinking skills, and daily routines.

• We practice tasks in the real spaces where you do them.

• I teach you safer, easier ways to move and complete daily routines.

• I help you build strength, confidence, and independence.

• Training on equipment like walkers, grab bars, shower chairs, or other tools.

• I adjust your home setup only when it directly helps your medical condition or daily function.

• Everyday activities like dressing, bathing, cooking, cleaning, and managing your home.

• Staying safe while moving around your house.

• Preventing falls and improving balance.

• Strengthening weak muscles and improving endurance.

• Teaching caregivers how to safely help you.

• Making small changes in your home to help you stay independent.