Elderly couple walking down the street, and the woman is using an arm cane.

February 17, 2023

Medicare’s Role in In-Home Assessments by Specially Certified Occupational Therapists

As we age, the risk of falling becomes a serious concern for seniors and their loved ones. Falls can lead to significant injuries, loss of independence, and increased healthcare costs. Thankfully, Medicare offers coverage for crucial preventive measures, such as in-home assessments conducted by occupational therapists with specialized certifications, to help seniors maintain their safety and well-being.

Understanding the Importance of Falls Prevention

Falls are a leading cause of injury among seniors, often resulting in fractures, head injuries, and long-term mobility issues. Preventive measures play a pivotal role in reducing these risks and ensuring seniors can lead active lives without constant worry about falls. One effective way to address this concern is through in-home assessments.

The Role of Occupational Therapists

Occupational therapists are healthcare professionals who specialize in helping individuals maintain or regain their independence and quality of life. When it comes to falls prevention, they assess the living environment to identify potential hazards and develop personalized strategies to mitigate them. These professionals offer recommendations to improve home safety, such as adding handrails, removing clutter, and suggesting assistive devices like grab bars and non-slip mats.  It is important to realize that occupational therapists come from a wide variety of backgrounds and when it comes to falls prevention, an OT with a specialized certification and years of experience in the field will be able to provide useful insight beyond that of someone new to an area like homecare for instance.  Most homecare agencies do not employ specially certified OT’s for the purpose of completing home safety assessments, so be sure to look for a company that specializes in only this aspect for the best results.

Medicare Coverage for In-Home Assessments

Medicare, the federal health insurance program for seniors aged 65 and older, plays a crucial role in supporting falls prevention. It covers in-home assessments by occupational therapists under certain circumstances. This coverage falls under Medicare Part B, which includes outpatient services. However, it’s important to note that Medicare will only cover these assessments if they are deemed medically necessary and if they are ordered by a doctor as part of a treatment plan.

Eligibility and Coverage Details

To be eligible for Medicare coverage of in-home assessments by occupational therapists, seniors must have a doctor’s prescription that outlines the medical necessity of the assessment. Once approved, Medicare will typically cover 80% of the Medicare-approved cost for the assessment, and the remaining 20% will be the responsibility of the beneficiary or their secondary insurance.

Steps to Obtain Coverage

            1. Consultation with a Doctor: Seniors should discuss their concerns with their primary care physician and request a prescription for an in-home assessment by an occupational therapist if deemed necessary.
            2.  Finding an Occupational Therapist: Locate an occupational therapist who accepts Medicare and is experienced in conducting falls prevention assessments.  Ask specifically if they are CEAC, CAPS, CLIPP or ECHM.
            3.  Scheduling the Assessment: Make an appointment with the occupational therapist for the in-home assessment. During this visit, the therapist will evaluate the living environment, assess the individual’s mobility and strength, and provide recommendations for enhancing safety.
            4. Billing and Reimbursement: The occupational therapist will bill Medicare directly for the covered services. The senior will be responsible for the 20% coinsurance unless they have a supplemental insurance plan to cover it.


Falls prevention is a crucial aspect of senior health and well-being. Medicare’s coverage for in-home assessments conducted by occupational therapists can significantly contribute to reducing the risk of falls among seniors. By taking advantage of this coverage, seniors can create safer living environments and enjoy greater peace of mind as they continue to age gracefully in their homes. If you or a loved one are eligible for Medicare, consider exploring this valuable coverage option to ensure a safer and more secure future.

Preventing Falls in Seniors