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December 2016 Texas Medicaid Provider Procedures Manual

Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook : 6 Adult Services : 6.2 Authorization Requirements for Outpatient and Home Health —PT, OT, and ST Services : 6.2.3 Requests for Recertification -Up to an Additional 60 days for Acute Services

6.2.3
A recertification request may be considered when services will be medically needed after the previously approved authorization period ends.
Reevaluation codes (procedure codes 97002, 97004, and S9152) require prior authorization and must be submitted with the recertification request. Required documentation for recertifications includes a progress summary and Texas Medicaid Physical, Occupational, or Speech Therapy (PT, OT, ST) Prior Authorization Form.
A complete recertification request must be received no earlier than 30 days before the current authorization period expires. Requests for recertification services received after the current authorization expires will be denied for dates of service that occurred before the date the submitted request was received.
One recertification request may be considered for an additional 60 days for each therapy service request with documentation supporting the medical necessity including all of the following:
Texas Medicaid Physical, Occupational, or Speech Therapy (PT, OT, ST) Prior Authorization Form or electronic equivalent signed and dated by the therapist and signed and dated by the ordering physician. When the request form is unsigned by the physician, it must be accompanied by a written order or prescription or a verbal order for the prescribed therapy services.
A progress summary which may be contained in the last treatment note, must be included with the recertification request and contains all of the following:

Texas Medicaid & Healthcare Partnership
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