Occupational Therapists work with children who have Sensory Processing
Disorder and who have co-existing diagnoses so they may bill for their
services by the other diagnoses.
Many Occupation Therapists are able to
give parents claim forms for Occupational Therapy services. Sensory Integration therapy is
one of the things that can provided to the child under an OT's license along
with the ability to give insurance claim forms to patients.
The child must be billed with a
diagnosis other than Sensory Processing Disorder or Autism.
About Insurance Codes For Sensory Processing Disorder
Updated 2016: We
recommend that families get a "formal" referral from an MD, since Occupation
Therapy is processed through the medical part of your insurance. The current
medical diagnoses would be from the ICD-10 (10th edition of the International
Classification of Diseases.
In the absence of another diagnosis (such as autism F84.0, ADHD
F90.0-90.9 depending on the type, etc.), some doctors are willing to use some
of the following:
M62.81 Muscle Weakness (Generalized)
G70.2 Congenital and/or Developmental Myasthenia
F82 Specific Developmental Disorder of Motor
If the child has adequate coordination but has suspected sensory issues,
some physicians use the diagnosis
F93.9 Childhood Emotional
Disorder, Unspecified or
of Central Nervous System, Unspecified
and for some:
R63.3 Feeding Difficulties, Oral
F50.9 Eating Disorder, Unspecified
Other Questions To Ask Your Insurance Provider
About Sensory Processing Disorder Coverage
Does my insurance plan cover Occupational Therapy?
Do I have to get a letter from a licensed medical
provider (Physician or Physician’s Assistant) to state this is medically
Do I need to send the letter from the medical provider
before seeing the Occupational
Therapy provider OR can it be submitted
with the first bill?
Is a diagnostic code required for reimbursement?
What is the reimbursement scale for Occupational Therapy?
What is the deductible on the plan? $__________ (amount)
Is there any deductible left to meet this year? $__________ (amount)
What is my co-payment per visit? $__________ (amount)
Is there a limit on the total amount that
can be paid out each year? $__________ (amount)
Is an Occupational Therapy
Evaluation covered by my
How many Occupational Therapy
sessions will be covered by
insurance in total per year? $__________(amount)
Does my coverage extend to the services of a non-network provider?
What is the maximum covered cost per Occupational Therapy session? $__________(amount)
What is the Co-payment per Occupational Therapy
Must we be referred for
Occupational Therapy by a medical doctor
or is an OTR sufficient?
If we are already in Occupational Therapy with another provider, what is my remaining coverage for
Occupational Therapy this year? $__________(amount)