Texas Medicaid and Use of Assistants

May 26, 2016
Rick Gawenda

Effective for dates of service on or after May 1, 2016, policy for physical therapy (PT), occupational therapy (OT), and speech therapy (ST) will change for the Texas Medicaid Comprehensive Care Program (CCP). Some of the key policy changes include:

  • Chronic therapy services will only be offered to clients who are birth through 20 years of age.
  • The authorization period for chronic therapy services will be 180 days.
  • Reevaluations require authorization and are part of the authorization/recertification process for chronic therapy service, and they will only be reimbursed when appropriate and when submitted with a recertification request.
  • A standardized test and standard deviation score must be submitted with each authorization or recertification request for chronic therapy services.
  • Starting May 27, 2016, providers requesting therapy services will be required to use a new prior authorization form.
  • All acute therapy services for clients birth through 20 years of age must be accompanied with the AT modifier.
  • Co-treatment services are outlined in this article, and all co-treatment services must be submitted with the appropriate modifier
  • All therapy services rendered by a licensed therapy assistant must be submitted with the appropriate modifier.

To read the complete article that defines acute services and chronic services, group therapy and documentation requirements for group therapy as well as provides the applicable modifiers that must be submitted when providing acute services, when co-treatments are provided and when the services are provided by a licensed assistant, click

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  1. This is only applicable to CORF and ORF, correct?

    This does not apply to acute care hospital therapy services, correct?

    What about patients who have Medicaid as secondary and are being seen in a general outpatient clinic? I am not sure exactly what defines an “ORF.” Is any outpatient facility that provides OT and PT and Speech considered an ORF?

    Just want to clarify. Thanks.