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December 2016 Texas Medicaid Provider Procedures Manual

Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook : 7 Claims Filing and Reimbursement : 7.2 Reimbursement/Billing Guidelines

7.2
Occupational therapist services are reimbursed in accordance with 1 TAC §355.8441.
Physical therapist services are reimbursed in accordance with 1 TAC §355.8441.
ST services are reimbursed in accordance with 1 TAC §355.8441. See the OFL or the applicable fee schedule on the TMHP website at www.tmhp.com for reimbursement rates.
CORFs and ORFs are reimbursed in accordance with 1 TAC §355.8441.
The physical, occupational and speech therapy procedure codes billed by a home health agency are reimbursed at the statewide visit rate calculated in accordance with 1 TAC §355.8021(a). Therapy procedure codes billed by other therapy providers are reimbursed in accordance with 1 TAC §355.8085.
Refer to:
Subsection 6.4, “Claims Filing Instructions” in “Section 6: Claims Filing” (Vol. 1, General Information) for general information about claims filing.
Subsection 6.5, “CMS‑1500 Paper Claim Filing Instructions” in “Section 6: Claims Filing” (Vol. 1, General Information) Blocks that are not referenced are not required for processing by TMHP and may be left blank.
Texas Medicaid implemented mandated rate reductions for certain services. The OFL and static fee percentage reductions applied. Additional information about rate changes is available on the TMHP website at www.tmhp.com/pages/topics/rates.aspx.
When there is a change of provider, or a change in the client’s medical condition requiring therapy, a denied claim for a therapy (PT, OT, or ST) evaluation, reevaluation or swallowing function evaluation that exceeded the limits outlined in this handbook may be considered on appeal for reimbursement with documentation of one of the following:

Texas Medicaid & Healthcare Partnership
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