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December 2016 Texas Medicaid Provider Procedures Manual

Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook : 5 Children’s Therapy Services Clients birth through 20 years of age : 5.1 * Services, Benefits, and Limitations : 5.1.1 Acute PT, OT, and ST Services

Acute PT, OT, and ST services are benefits of Texas Medicaid for the medically necessary short term treatment of an acute medical condition or an acute exacerbation of a chronic medical condition.
Treatments are expected to significantly improve, restore or develop physical functions diminished or lost as a result of a recent trauma, illness, injury, disease, surgery, or change in medical condition, in a reasonable and generally predictable period of time (60 days), based on the prescribing provider’s and therapist’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 must meet acceptable standards of medical practice and be specific and effective treatment for the client’s condition.
Services are provided within the provider’s scope of practice, as defined by state law.
Acute is defined as an illness or trauma with a rapid onset and short duration.
A medical condition is considered chronic when 120 days have passed from the start of therapy or the condition is no longer expected to resolve or may be slowly progressive over an indefinite period of time.
With documentation of medical need physical, occupational, and speech therapy may continue for a maximum of 120 days for an acute medical condition or an acute exacerbation of a chronic medical condition.
Once the client’s condition is no longer considered acute, continued therapy for a chronic condition will only be considered for clients who are 20 years of age or younger.

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