TMPPM 2010 > Nursing and Therapy
Services Handbook > Therapists, Independent Practitioners, and Physicians > Services, Benefits, Limitations, and Prior Authorization

5.2 Services, Benefits, Limitations, and Prior Authorization

Occupational therapy (OT), physical therapy (PT), and speech therapy (ST) are benefits of Texas Medicaid for an acute condition or an exacerbation of a chronic condition when all of the following criteria are met:

•Treatments are expected to significantly improve the client's condition in a reasonable and generally predictable period of time, based on the physician's assessment of the client's restorative potential.

•Treatments are directed towards restoration of or compensation for lost function.

•Services do not duplicate those provided concurrently by any other therapy.

•Services are provided within the provider's scope of practice, as defined by state law.

Therapy may be performed by auxiliary personnel under the direct supervision of the physician or the independently practicing therapist.

OT, PT, and ST that is not a benefit of traditional Medicaid may be covered:

•In the physician's office, or Medicaid-enrolled private therapist's office for a chronic condition

•Through the school health and related services (SHARS) program

•In an outpatient rehabilitation or free-standing rehabilitation facility

•In a licensed hospital

In addition, OT, PT, and ST services that are not benefits of traditional Medicaid may be benefits under CCP.

Refer to: Subsection 3.10, "Therapy Services (CCP)" in Children's Services Handbook (Vol.2, Provider Handbooks) for therapy benefits for clients who are 20 years of age or younger.