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HB4 PT, OT, ST, and Related Durable Medical Equipment Services: Telehealth and Exclusions

Last updated on 7/15/2022

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, precertification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

Effective September 1, 2022, the Texas Health and Human Services Commission (HHSC) will transition certain COVID-19 flexibilities to permanent guidance in line with House Bill (H.B.) 4 (87th Legislature, Regular Session, 2019). This will include some physical therapy (PT), occupational therapy (OT), and speech therapy (ST) services delivered by synchronous audiovisual technology for adults and children.

Synchronous Audiovisual PT, OT, and ST Evaluation and Treatment

Evaluation, reevaluation, and treatment of some PT, OT, and ST services may be provided by synchronous audiovisual technology.

Providers must defer to the needs of the client receiving services, allowing the mode of service delivery (synchronous audiovisual or in-person) to be accessible, person- and family-centered, and driven primarily by the client’s choice and not provider convenience.

PT, OT, or ST services may be provided through synchronous audiovisual technology for specific procedure codes if it’s safe, agreed to by the client receiving services or by their legally authorized representative (LAR), clinically appropriate as determined by the practitioner and standard of care, and in compliance with each discipline’s rules.

The provider should obtain informed consent for treatment from the client, the client’s parent, or the client’s legal guardian before providing a telehealth service. Verbal consent is permissible and should be documented in the client’s medical record.

Services delivered by synchronous audiovisual technology may require the participation of a parent or caregiver to assist with the treatment.

The following services may be provided through telehealth delivery using synchronous audiovisual technology:


Procedure Codes

PT evaluations and reevaluations

97161, 97162, 97163, 97164

OT evaluations and reevaluations

97165, 97166, 97167, 97168

PT and OT treatments

97110, 97112, 97116, 97150, 97530, 97535, 97537, 97750

ST evaluations and reevaluations

92521, 92522, 92523, 92524, 92610, S9152

ST treatments

92507, 92508, 92526

Note: Community reintegration (procedure code 97537) may be provided if the client receiving services is currently receiving other therapeutic procedures, and it may not be billed separately.

Therapy assistants may provide telehealth and receive supervision using synchronous audiovisual technology within limits outlined in each discipline’s rules. Providers should refer to state practice rules and national guidelines regarding supervision requirements for each discipline.

Telehealth services must adhere to documentation, privacy, and security requirements as outlined in the current Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook and those in the Telecommunication Services Handbook (Vol. 2, Provider Handbooks).

Claim and Documentation Requirements

Providers must submit claims with modifier 95 for services delivered by synchronous audiovisual technology to indicate remote delivery.

Reminder: Providers must also submit the required modifiers GP, GO, and GN on all physical, occupational, and speech therapy treatment claims.

Documentation requirements for a telehealth service are the same as for an in-person visit. Documentation must accurately reflect the services rendered and identify the means of delivery when the services are provided by telehealth.

The Texas Medicaid Provider Procedures Manual, Telecommunication Services Handbook will be updated to include more information about telehealth services documentation requirements, including requirements for informed consent.

Telehealth Exclusions

Any PT, OT, or ST service delivered through synchronous telephone (audio-only) technology will not be reimbursed.

Certain procedure codes will not be reimbursed for any telehealth service delivery. The following PT, OT, and ST evaluation and treatment procedure codes must be provided in person:

Procedure Codes






















Augmentative Communication Device Systems

Specialized evaluations required for the provision of new, complex rehabilitation technology, such as augmentative communication devices, require the physical, in-person presence of the rendering provider.

Mobility Aids

Specialized evaluations required for the provision of new, complex rehabilitation technology, such as power mobility and adaptive seating systems, require the physical, in-person presence of the rendering provider.

Texas Medicaid may reimburse only for seating assessments, fittings, or trainings completed in person.

Declaration of a State of Disaster

Under a declaration of a state of disaster, the Texas Health and Human Services Commission (HHSC) may issue direction to providers regarding the use of a telemedicine or telehealth service to include the use of a synchronous telephone (audio-only) platform to provide covered services outside the allowances described in this article, to the extent permitted by Texas law. A declaration of a state of disaster occurs when an executive order or proclamation is issued by the governor declaring a state of disaster in accordance with Section 418.014 of the Texas Government Code.

For more information, call the TMHP Contact Center at 800-925-9126.