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December 2016 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2 Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.7 Early Childhood Intervention (ECI) Services : 2.7.2 * Services, Benefits, Limitations, and Prior Authorization : 2.7.2.2 * Therapy

2.7.2.2
Providers may submit claims for therapy services that are included in the client’s IFSP.
A client may receive a combination of PT, OT, ST, or specialized skills training (SST) in the home or community setting, including a PPECC, when the IFSP indicates necessity for two services to be provided at the same time and the parents have agreed on the two services being provided at the same time.
When ECI therapy services are rendered in a PPECC, the ECI provider must document coordination with the PPECC.
PT, OT, and ST equipment and supplies used during therapy visits are included in the therapy visit and are not reimbursed separately.
2.7.2.2.1
ECI contractors must submit claims for PT, OT, and ST services using their own Texas Provider Identifier (TPI) and National Provider Identifier (NPI) with the following procedure codes for services that are rendered in the home, office, or other community settings:
 
ECI contractors must use the UB modifier to identify therapy provided by a licensed assistant acting under the direction of the Medicaid-enrolled occupational therapist, physical therapist, or speech language therapist.
2.7.2.2.2
OT procedure codes must be submitted with modifier GO.
The following procedure codes must be submitted in 15-minute increments:
 
The following procedure codes are limited to once per date of service, for each therapy type (PT and OT):
 
OT includes services that address the functional needs of a client that are related to adaptive development, adaptive behavior and play, and sensory, motor, and postural development. These services are designed to improve the client’s functional ability to perform tasks in the home and community settings.
Occupational therapist services are provided by an ECI provider. The ECI provider ensures that occupational therapist services are performed by one of the following:
A certified occupational therapist assistant (COTA) when the assistant is acting under the direction of a licensed occupational therapist in accordance with 42 CFR §440.110 and all other applicable state and federal laws.
2.7.2.2.3
PT procedure codes must be submitted with modifier GP.
The following PT procedure codes may be reimbursed for therapy services and must be submitted in 15-minute increments:
 
The following procedure codes are limited to once per date of service, for each therapy type (PT and OT):
 
PT includes services that address the promotion of sensory and motor function through enhancement of musculoskeletal status, neurobehavioral organization, perceptual and motor development, cardiopulmonary status, and effective environmental adaptation.
Physical therapist services are provided by an ECI provider. The ECI provider ensures that physical therapist services are performed by one of the following:
A licensed PT assistant (LPTA) when the assistant is acting under the direction of a licensed physical therapist in accordance with 42 CFR §440.110 and all other applicable state and federal laws.
2.7.2.2.4
ST procedure codes must be submitted with modifier GN.
The following ST procedure codes may be reimbursed for therapy services and must be submitted in 15-minute increments:
 
Speech and language therapy includes services designed to promote rehabilitation and remediation of delays or disabilities in language-related symbolic behaviors, communication, language, speech, emergent literacy, or feeding and swallowing behavior.
ST services are provided by an ECI provider. The ECI provider ensures that ST services are performed by one of the following:

Texas Medicaid & Healthcare Partnership
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