12.1 Overview

Outpatient therapy services refer to any core service identified in Appendix B: Post-Acute Rehabilitation Core Services – Modality and Staff Qualifications including, but not limited to: occupational therapy, physical therapy, speech therapy, mental health counseling, and substance abuse services. Outpatient therapy services are provided on a one-on-one basis by licensed therapists to participants who have a traumatic brain injury, a traumatic spinal cord injury, or both.

A physician must prescribe outpatient therapy services (as applicable) and are provided without admittance to a hospital. The goal is to correct or modify a stable or slowly progressive physical or mental impairment that constitutes a substantial impediment to independence.
Goods and services that are not considered outpatient therapy services are considered ancillary. See Chapter 14: Traumatic Brain Injury and Traumatic Spinal Cord Injury – Ancillary Goods and Services for billing guidelines and reimbursement of ancillary services.