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SPD Bay Area Resource Group and SPD-TIPS Group provide free information, resources and support to Parents.
We help parents learn how to recover a child diagnosed with Sensory Processing Disorder (SPD).
SPD is also known as Sensory Integration Dysfunction (SID) or Dysfunction of Sensory Integration (DSI).

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Questions to Ask Your Insurance Company About Occupational Therapy for Sensory Processing Disorder SPD

SPD Diagnostic Codes

In the current ICD diagnostic manual there are no recognized procedural codes for or Sensory Processing Disorder (Sensory Integration Dysfunction, Dysfunction of Sensory Integration.)

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, however, must be billed with a diagnosis other than Sensory Processing Disorder or Autism.

Read more about Insurance Questions for Occupational Therapy.
  1. Does my insurance plan cover Occupational Therapy?
     
  2. Do I have to get a letter from a licensed medical provider (Physician or Physician’s Assistant) to state this is medically necessary?
     
  3. 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?
     
  4. Is a diagnostic code required for reimbursement?
     
  5. What is the reimbursement scale for Occupational Therapy?
     
  6. What is the deductible on the plan? $__________ (amount)
     
  7. Is there any deductible left to meet this year?
    $__________ (amount)
     
  8. What is my co-payment per visit? $__________ (amount)
     
  9. Is there a limit on the total amount that can be paid out each year? $__________ (amount)
     
  10. Is an Occupational Therapy Evaluation covered by my insurance? $__________(amount)
     
  11. How many Occupational Therapy sessions will be covered by insurance in total per year?     $__________(amount)
     
  12. Does my coverage extend to the services of a non-network provider?
     
  13. What is the maximum covered cost per Occupational Therapy session?    $__________(amount)
     
  14. What is the Co-payment per Occupational Therapy session?  
    $__________(amount)
     
  15. Must we be referred for Occupational Therapy by a medical doctor or is an OTR sufficient?
     
  16. If we are already in Occupational Therapy with another provider, what is my remaining coverage for Occupational Therapy this year? $__________(amount)
     
  17. Does my insurance cover the following codes:
    • 315.4    coordination disorder
    • 728.9    disorder of muscle ligament/muscle hypotonicity
    • 781.3    motor incoordination
    • 781.92  abnormal posture

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