Occupational Therapists in Private Practice

Occupational Therapists in Private Practice

A. Private Practice
Section 42 CFR 410.59(c)(ii), (iii), and (iv) state that an occupational therapist in private practice must:
(1) Engage in the private practice of occupational therapy on a regular basis as an individual, in one of the following practice types:
(a) An unincorporated solo practice.
(b) A partnership or unincorporated group practice.
(c) An unincorporated solo practice, partnership, or group practice, or a professional corporation or other incorporated occupational therapy practice.
(d) An employee of a physician group.
(e) An employee of a group that is not a professional corporation.
AND
(2) Bill Medicare only for services furnished in his or her private practice office space, or in the patient's home.
(a) A therapist's private practice office space refers to the location(s) where the
practice is operated, in the state(s) where the therapist (and practice, if applicable) is legally authorized to furnish services, during the hours that the therapist engages in practice at that location. When services are furnished in private practice office space, such space must be owned, leased, or rented by the practice and used for the exclusive purpose of operating the practice.
(b) A patient's home does not include any institution that is a hospital, a CAH, or a SNF.
AND
(3) Treat individuals who are patients of the practice and for whom the practice collects fees for the services furnished.

B. Regulatory Definition
Section 42 CFR § 484.4 defines an occupational therapist as an individual who:
(1)(a) Is licensed or otherwise regulated, if applicable, as an occupational therapist by the state in which practicing, unless licensure does not apply;
(b) Graduated after successful completion of an occupational therapist education program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) of the American Occupational Therapy Association, Inc. (AOTA), or successor organizations of ACOTE; and
(c) Is eligible to take, or has successfully completed the entry-level certification examination for occupational therapists developed and administered by the National Board for Certification in Occupational Therapy, Inc. (NBCOT).
OR
(2) On or before December 31, 2009--
(a) Is licensed or otherwise regulated, if applicable, as an occupational therapist by the state in which practicing; or
(b) When licensure or other regulation does not apply--
(i) Graduated after successful completion of an occupational therapist education program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) of the American Occupational Therapy Association, Inc. (AOTA) or successor organizations of ACOTE; and
(ii) Is eligible to take, or has successfully completed the entry-level certification examination for occupational therapists developed and administered by the National Board for Certification in Occupational Therapy, Inc., (NBCOT).
OR
(3) On or before January 1, 2008--
(a) Graduated after successful completion of an occupational therapy program accredited jointly by the committee on Allied Health Education and Accreditation of the American Medical Association and the American Occupational Therapy Association; or
(b) Is eligible for the National Registration Examination of the American Occupational Therapy Association or the National Board for Certification in Occupational Therapy.
OR
(4) On or before December 31, 1977--
(a) Had 2 years of appropriate experience as an occupational therapist; and (b) Had achieved a satisfactory grade on an occupational therapist proficiency examination conducted, approved, or sponsored by the U.S. Public Health Service.

C. Education Outside the United States

Section 42 CFR § 484.4 states that if the occupational therapist was educated outside the United States, he or she must meet all of the following:
(1) Graduated after successful completion of an occupational therapist education program accredited as substantially equivalent to occupational therapist entry level education in the United States by one of the following:
(a) The Accreditation Council for Occupational Therapy Education (ACOTE).
(b) Successor organizations of ACOTE.
(c) The World Federation of Occupational Therapists.
(d) A credentialing body approved by the American Occupational Therapy Association.
(2) Successfully completed the entry-level certification examination for occupational therapists developed and administered by the National Board for Certification in Occupational Therapy, Inc. (NBCOT).
(3) On or before December 31, 2009, is licensed or otherwise regulated, if applicable, as an occupational therapist by the state in which practicing.

D. Additional References
See Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15:
• Section 230.2(B) for more detailed information regarding the required qualifications of occupational therapists.
• Section 230.4 for detailed information regarding the term “private practice.”