Oklahoma Administrative Code
Title 317 - Oklahoma Health Care Authority
Chapter 30 - Medical Providers-Fee for Service
Subchapter 5 - Individual Providers and Specialties
Part 28 - OCCUPATIONAL THERAPISTS AND OCCUPATIONAL THERAPY ASSISTANTS
Section 317:30-5-296 - Coverage by category; payment rates and procedure codes

(1) Children. Initial therapy evaluations do not require prior authorization and must be provided by a fully licensed occupational therapist. All therapy services following the initial evaluation must be prior authorized for continuation of service. Prior to the initial evaluation, the therapist must have on file a signed and dated prescription or referral for the therapy services from the member's physician or other licensed practitioner of the healing arts. The prescribing or referring provider must be able to provide, if requested, clinical documentation from the member's medical record that supports the medical necessity for the evaluation and referral.

(2) Adults. There is no coverage for adults for services rendered by individually contracted providers. Coverage for adults is permitted in an outpatient hospital setting as described in Oklahoma Administrative Code(OAC) 317:30-5-42.1.

(3) Individuals eligible for Part B of Medicare. Services provided to Medicare eligible recipients are filed directly with the fiscal agent.