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2012 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2. Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.10 Therapy Services (CCP)

2.10 Therapy Services (CCP)
OT, PT, and ST services beyond the limitations of Texas Medicaid and Title XIX Home Health Services are benefits of the CCP for clients who are birth through 20 years of age and who are CCP eligible when:
Documentation of medical necessity supports a condition that requires ongoing therapy or rehabilitation in the usual course, treatment, and management of the client's condition.
This section does not apply to CORFs and ORFs.
Refer to:
Subsection 2.11, “Inpatient Rehabilitation Facility (Freestanding) (CCP)” in this handbook.
Therapy may be performed by a licensed occupational therapist, physical therapist, speech therapist, or one of the following under the supervision of a licensed therapist: licensed therapy assistant or licensed speech-language pathology intern.
Services performed by an OT aide, OT orderly, OT student, OT technician, PT aide, PT orderly, PT student, PT technician, SLP aide, SLP orderly, SLP student, or SLP technician are not a benefit of Texas Medicaid.
Therapy services performed by an unlicensed provider are subject to retrospective review and recoupment.
OT, PT, and ST may be performed in the office or home setting and may be authorized to be provided in the following locations: home of the client, home of the caregiver/guardian, client's daycare facility, or the client's school.
Services provided to a client on school premises are only permitted when delivered before or after school hours. The only CCP therapy that can be delivered in the client's school during regular school hours are those delivered by school districts as SHARS in POS 9.
Refer to:
Section 3, “School Health and Related Services (SHARS)” in this handbook for more information about SHARS.
PT provided in the nursing home setting is limited to the nursing facility because it must be available to nursing home residents on an “as needed” basis and must be provided directly by the staff of the facility or furnished by the facility through arrangements with outside-qualified resources. Nursing home facilities must refrain from admitting clients who need goal directed therapy if the facility is unable to provide these services.
Home health agencies that perform therapy services under CCP are allowed one visit per day per therapy type and paid at the statewide visit rate.
Services That Are Not a Benefit
The following services are not a benefit of CCP.
Separate reimbursement for VitalStim® therapy for dysphagia.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.