Therapy Caps and Variation in Cost of Outpatient Occupational Therapy by Provider, Insurance Status, and Geographic Region.

Journal Article (Journal Article)

OBJECTIVE: This article describes the cost of occupational therapy by provider, insurance status, and geographic region and the number of visits allowed and out-of-pocket costs under proposed therapy caps. METHOD: This retrospective, population-based study used Medicare Provider Utilization and Payment Data for occupational therapists billing in 2012 and 2013 (Ns = 3,662 and 3,820, respectively). We examined variations in outpatient occupational therapy services with descriptive statistics and the impact of therapy caps on occupational therapy visits and patient out-of-pocket costs. RESULTS: Differences in cost between occupational and physical therapists were minimal. The most frequently billed service was therapeutic exercises. Wisconsin had the most inflated outpatient costs in both years. Under the proposed therapy cap, patients could receive an evaluation plus 12-14 visits. DISCUSSIO: . Wide variation exists in potential patient out-of-pocket costs for occupational therapy services on the basis of insurance coverage and state. Patients without insurance pay a premium.

Full Text

Duke Authors

Cited Authors

  • Pergolotti, M; Lavery, J; Reeve, BB; Dusetzina, SB

Published Date

  • 2018

Published In

Volume / Issue

  • 72 / 2

Start / End Page

  • 7202205050p1 - 7202205050p9

PubMed ID

  • 29426383

Pubmed Central ID

  • PMC5807401

International Standard Serial Number (ISSN)

  • 0272-9490

Digital Object Identifier (DOI)

  • 10.5014/ajot.2018.023796


  • eng

Conference Location

  • United States