Frequently Asked Questions
Will my Insurance Cover these Services?
Please contact your insurance company to determine if your insurance will cover these specialized services.
- The services would be billed under the “Occupational Therapy’ benefit.
- The evaluation codes we would use are 97166-97168 for initial consultation/evaluation.
- The treatment codes we use are 97535, 97112, 97530, or 97110.
You will want to ask your insurance company:
- Do I have out of network benefits? If so, What percentage would be reimbursed?
- I will need to submit for my own reimbursement, how do I do this once I pay Buffalo Occupational Therapy?
Out-of-Pocket Rates
If you are paying for services out of pocket, you will be required to pay at the time of visit.
Our rates are very straightfoward:
- $250 for the initial consultation
- $175 for each re-certification period (every 10-12 weeks)
- $105 for each treatment session thereafter
Those who are electing to use Care Credit, will complete this Care Credit process prior to the first session taking place to ensure the cost of services are covered.
Clinical Safety and Care Planning
To support the safety of clients and clinical staff, some individuals may require additional care planning prior to or during outpatient occupational therapy services. This may include clients with complex or medically fragile health profiles, recent medical changes, or conditions that affect safety, orientation, or supervision needs.
In certain situations, documentation from a neurologist or relevant medical specialist may be requested to confirm that medical, cognitive, and physical status is stable and appropriate for outpatient care.
Additional safety planning may also include the recommendation for a designated care partner to remain onsite during appointments. This may apply to individuals with episodic neurological symptoms, recent changes in medical status, reduced safety awareness or disorientation, or other factors that increase supervision needs during therapy sessions.
These considerations are determined on an individualized, functional basis and are intended to ensure appropriate clinical support and a safe therapeutic environment. They do not affect eligibility for services and are discussed collaboratively as part of care planning.
Late Cancelation Fee and No-Show Fee
The following fees are automatically invoiced and apply to all clients of Buffalo Occupational Therapy without exception.
- If you are more than 15 minutes late, you will not be seen for that day and you will incure a $50 fee.
- If you cancel for any reason within 24 hours, this is a $50 fee.
- If there is not a confirmed travel ban or advisory in your area or our area, and there is an appointment cancelation within 24 hours of your appointment, there is a $50 fee.
Can you contact my insurance company for me?
Buffalo Occupational Therapy is no longer calling/contacting/acting as a liason/contracting with insurance companies.
What insurance do you take?
Buffalo Occupational Therapy accepts Medicare Primary insurance and some Independent Health Insurance Plans.
Please e-mail us for more information: [email protected]