TMPPM 2008 > Texas Medicaid Services > School Health and Related Services (SHARS) > Benefits and Limitations

    
 

42.6.5.1 Occupational Therapy Billing Table

POS*
Procedure Code
Individual or Group
Therapist or Licensed/Certified Assistant

1, 2, or 9

1-97003

Individual

Licensed therapist

1, 2, or 9

1-97530 with modifier GO

Individual

Licensed therapist

1, 2, or 9

1-97530 with modifier GO-U1

Individual

Licensed/certified assistant

1, 2, or 9

1-97150 with modifier GO

Group

Licensed therapist

1, 2, or 9

1-97150 with modifier GO-U1

Group

Licensed/certified assistant

*Place of Service: 1=office/school; 2=home; 9=other locations

Providers must use a 15-minute unit of service for billing.

Refer to: "Billing Units Based on 15 Minutes" .

The recommended maximum billable time for OT evaluation is one hour, which may be billed over several days. The recommended maximum billable time for direct therapy (group and/or individual) is a cumulative of one hour per day. Providers must submit documentation of the reasons for the additional time, if more than the recommended maximum time is billed.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2007 American Medical Association. All rights reserved.
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