Since the commencement of the government health insurance program in 1977, there has been criticism that the national insurance fee for health care service had been set too low by the Korean government. The existing insurance fee schedule for occupational therapy service was developed first in 1980 in Korea. But they are not reflecting the current health care environment. Even though the fee schedule has been revised almost every year, the fee has been estimated too low to warrant a quality service. To make the situation worse, Health Insurance Review Agency has recently proposed to substantially cut down the fee for occupational therapy service. Many medical institutions opening occupational therapy clinics are avoiding investment in this “financial deficit” department. This is threatening the survival of the occupational therapy profession that is essential for rehabilitation process. The objective of this study is to review and analyze the current Korean health insurance fee schedule and its changing process in occupational therapy service and suggest the better solutions. The researcher suggests that the health insurance fee schedule must cover computer-based occupational therapy, a Pediatric occupational therapy and evaluation, and treatment for the use of equipment such as Baltimore Therapeutic Equipment. Also, the government must increase the fee for occupational therapy service at least up to the level of consumer price index.