Table of Contents Previous Next

December 2016 Texas Medicaid Provider Procedures Manual

Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook : 6 Adult Services : 6.1 Services, Benefits, and Limitations

6.1
Unless otherwise specified, “days” refers to calendar days.
Physical therapy (PT), occupational therapy (OT), and speech therapy (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 for clients who are 21 years of age and older.
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.
Note:
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.
Adult therapy services are limited to a maximum of 120 days per identified acute medical condition or acute exacerbation of a chronic medical condition requiring therapy or whenever the maximum benefit from therapy has been achieved, whichever comes first.
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.
Physical and occupational therapy services for acute conditions are benefits of Texas Medicaid for adult clients in the office, outpatient, and home settings.
Speech therapy services for acute conditions are benefits of Texas Medicaid for adult clients in the office and outpatient setting only.
Therapy services must be performed by one of the following:
Therapy services may also be performed by one of the following under the supervision of a licensed therapist of the specific discipline:

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