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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 : 5.2 Authorization Requirements for PT, OT, and ST Services : 5.2.6 Requests for Revisions to Existing Prior Authorizations or Recertification for Acute and Chronic Therapy Services

5.2.6
A revision to an existing authorization/recertification must be documented in the client’s record when significant changes occur in the frequency or treatment plan. When frequency is increased, or services requiring separate authorization are added, a request for revision must be submitted for prior authorization.
Requests for revisions must be received no later than five business days from the date the revised therapy treatments are initiated. Requests for revisions received after the five business day period will be denied for dates of service that occurred before the date the request was received.
A prior authorization request for revisions to services may be considered up to the end of the current approved prior authorization.
Requests for revision must be submitted with the following documentation:
Texas Medicaid Physical, Occupational, or Speech Therapy (PT, OT, ST) Prior Authorization Form, including the date the revision was initiated, signed and dated by the therapist and signed and dated by the prescribing provider. When the request form is not signed and dated by the prescribing provider, it must be accompanied by a written order or prescription or a verbal order for the prescribed services.
Updated treatment plan or POC addressing all the elements of the previous plan and addressing all revisions to the services planned, including updated or new functional and measurable short and long-term treatment goals with new time frames, as applicable. Previous authorization period’s goals and progress must be included.

Texas Medicaid & Healthcare Partnership
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