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December 2016 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 3 School Health and Related Services (SHARS) : 3.3 Services, Benefits, Limitations, and Prior Authorization : 3.3.5 Occupational Therapy (OT) : 3.3.5.2 Description of Services

3.3.5.2
OT evaluation services include determining what services, assistive technology, and environmental modifications a student requires for participation in the special education program.
OT includes:
OT must be provided by a professional who is licensed by the Texas Board of Occupational Therapy Examiners or a COTA acting under the supervision of a qualified occupational therapist.
OT evaluation is billable on an individual (procedure code 97003) basis only. OT is billable on an individual (procedure code 97530) or group (procedure code 97150) basis.
The occupational therapist or COTA can only bill for time spent with the student present, including time spent assisting the student with learning to use adaptive equipment and assistive technology.
Time spent without the student present, such as training teachers or aides to work with the student (unless the student is present during the training time), report writing, and time spent manipulating or modifying the adaptive equipment is not billable.
Session notes are not required for procedure code 97003; however, documentation must include the billable start time, billable stop time, total billable minutes, and must note the activity that was performed (e.g., OT evaluation).
Session notes are required for procedure codes 97530 and 97150. Session notes must include the billable start time, billable stop time, total billable minutes, activity performed during the session, student observation, and the related IEP objective.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.