Therapy Comply - Medicaid Coverage of Occupational Therapy in all 50 States

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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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50 State Surveys
Medicaid Coverage of Occupational Therapy in all 50 States

Medicaid Coverage of Occupational Therapy Services

Below is the basic Medicaid coverage information for occupational therapy services for children and adults in each state. Medicaid managed care plans must provide the same amount of coverage but can change prior authorization requirements. Members can email us with questions or request information on Medicaid issues at any time and have access to the guides on the state Medicaid pages.

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Zachary Edgar JD, LLM is the managing partner for Therapy Comply. Zachary is a healthcare attorney that specializes in federal and state healthcare regulatory issues particularly for physical, occupational, and speech therapy practices.

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State	Children	Adults
Alabama	Alabama Medicaid covers occupational therapy for children without prior authorization.	Alabama Medicaid does not cover occupational therapy for adults.
Alaska	Alaska Medicaid covers occupational therapy for both adults and children when medically necessary and ordered by a physician, advanced nurse practitioner, or other licensed health care practitioner.	Alaska Medicaid covers occupational therapy for both adults and children when medically necessary and ordered by a physician, advanced nurse practitioner, or other licensed health care practitioner.
Arizona	Arizona Medicaid covers outpatient occupational therapy services are covered for ALTCS members and members under the age of 21.	Arizona Medicaid covers occupational therapy services provided to all members who are receiving inpatient care at a hospital, nursing facility, and custodial care facility when services are ordered by the member’s PCP/attending physician.
Arkansas	Arkansas Medicaid and ARKids First-A will pay for occupational therapy for patients who are younger than 21.	Arkansas Medicaid does not cover outpatient occupational therapy for adults.
California	California Medicaid or Medi-Cal covers occupational therapy for children with prior approval.	California Medicaid or Medi-Cal covers occupational therapy for adults with prior approval. Limited to two (2) visits a month.
Colorado	Colorado Medicaid covers occupational therapy for children, prior authorization may be required.	Colorado Medicaid covers occupational therapy for children, prior authorization may be required.
Connecticut	Connecticut Medicaid covers occupational therapy services for children. Prior authorization is needed for greater than one (1) evaluation on per year, per provider, and more than one (1) visit per week, per provider.	Connecticut Medicaid covers occupational therapy services for children. Prior authorization is needed for greater than one (1) evaluation on per year, per provider, and more than one (1) visit per week, per provider.
Delaware	Delaware Medicaid covers occupational therapy services for children.	Delaware Medicaid covers occupational therapy services for adults.
Florida	All Florida Medicaid recipients who are 20 years of age or younger and not in a long-term care plan may receive occupational therapy services in accordance with the coverage and limitations policy.	All Florida Medicaid recipients who are 18 years of age or older who are in a Long-Term Care or Comprehensive Long-Term Care plan may receive occupational therapy. Recipients 21 years of age and older may receive limited services pertaining to wheelchair evaluations and fittings. OT services are otherwise not covered for adults.
Georgia	Georgia Medicaid covers occupational therapy for children. Prior authorization after 8 units per month.	Georgia Medicaid does not cover occupational therapy for adults.
Hawaii	Hawaii Medicaid allows up to 36 units or 12 visits of PT and/or OT for children as long as these services(s) does not/do not exceed 36 units, or 12 visits for PT and/or OT in a 12-day period. Prior authorization is required after limits are reached.	Hawaii Medicaid allows up to 36 units or 12 visits of PT and/or OT for adults as long as these services(s) does not/do not exceed 36 units, or 12 visits for PT and/or OT in a 12-day period. Prior authorization is required after limits are reached.
Idaho	Idaho Medicaid covers occupational therapy for children.	Idaho Medicaid covers occupational therapy for adults.
Illinois	Illinois Medicaid covers occupational therapy for children with prior approval.	Illinois Medicaid covers occupational therapy for adults with prior approval.
Indiana	Indiana Medicaid covers rehabilitative occupational therapy services for members under 21 years of age when determined medically necessary. Indiana Medicaid covers habilitative occupational therapy services for members under 21 years of age on a case-by-case basis, subject to prior authorization.	For members 21 years of age and older, Indiana Medicaid covers rehabilitative occupational therapy services for no longer than two (2) years from the initiation of the therapy, unless a significant change in medical condition requires longer therapy. Habilitative therapy is not a covered service for members 21 years of age and older.
Iowa	Iowa Medicaid covered occupational therapy for children.	Iowa Medicaid covered occupational therapy for adults.
Kansas	Habilitative therapy is covered only for participants zero to under 21 years of age. Kansas Medicaid covers developmental occupational therapy services are covered for children under 21 years of age.	Kansas Medicaid covers occupational therapy for adults 21 years of age and over only when rehabilitative in nature and provided following physical debilitation due to an acute physical trauma or illness. Therapy services are limited to up to six (6) consecutive months per injury or illness for participants 21 years of age and older.
Kentucky	Kentucky Medicaid covers occupational therapy for children up to twenty (20) visits a year, prior authorization for additional visits.	Kentucky Medicaid covers occupational therapy for adults up to twenty (20) visits a year, prior authorization for additional visits.
Louisiana	Louisiana Medicaid covers occupational therapy with prior authorization, recipients 0 through 20 years of age.	Louisiana Medicaid only covers occupational therapy for adults in outpatient hospital settings, with prior authorization.
Maine	Maine covers occupational therapy services for children.	Maine Medicaid covers occupational therapy for adults with limitations, prior authorization is required. Services for maintenance care are limited to two (2) visits per year. Services for rehabilitation are limited to six (6) visits per condition.
Maryland	Maryland Medicaid covers occupational therapy services for children. Providers of occupational therapy services should bill FFS Medicaid for participants under 21 years of age.	Maryland Medicaid covers occupational therapy services for adults. Therapists must contact the MCO for preauthorization for participants 21 years of age and older.
Massachusetts	Massachusetts Medicaid or Mass Health covers occupational therapy for children with prior authorization.	The MassHealth agency requires that the occupational therapist obtain prior authorization as a prerequisite to payment for the following services to eligible MassHealth members: More than twenty (20) occupational-therapy visits or twenty (20) physical-therapy visits, including group therapy visits but not including evaluations, for a member in a twelve (12) month period; More than two (2) evaluations in a twelve (12) month period.
Michigan	Michigan Medicaid covers occupational therapy for children. Outpatient: Up to 144 units of OT per calendar year period. Nursing Facility: OT performed within 60 days of the beneficiary’s admission to the facility. Home Health: Up to 24 visits of OT in one 60 consecutive day period. Prior authorization is required after the limits are reached.	Michigan Medicaid covers occupational therapy for adults. Outpatient: Up to 144 units of OT per calendar year period. Nursing Facility: OT performed within 60 days of the beneficiary’s admission to the facility. Home Health: Up to 24 visits of OT in one 60 consecutive day period. Prior authorization is required after the limits are reached.
Minnesota	Minnesota Medicaid covers occupational therapy for children without prior authorization. Specialized maintenance therapy coverage is limited to MHCP members aged 20 and younger.	Minnesota Medicaid covers occupational therapy for adults without prior authorization.
Mississippi	Mississippi Medicaid covers occupational therapy for children with prior authorization.	Mississippi Medicaid covers occupational therapy for adults with prior authorization
Missouri	Missouri Medicaid covered occupational therapy services for children.	Missouri Medicaid has limited occupational therapy coverage for adults. Habilitative Services: The combination of all habilitative skilled therapy services for the adult expansion group is limited to a total of twenty (20) visits per rolling year, inclusive of services from all MHD providers. Participants 19 to 20 years old in the adult expansion group may receive all medically necessary habilitative skilled therapy services. Prior authorization is not required.
Montana	Montana Medicaid covers occupational therapy for children.	Montana Medicaid covers occupational therapy for adults.
Nebraska	Nebraska Medicaid covers occupational therapy services for children.	For recipients age 21 and older, Nebraska Medicaid limits coverage to a combined total of sixty (60) therapy sessions per fiscal year. The combined total of sixty (60) therapy sessions per fiscal year includes all occupational therapy, physical therapy, speech pathology, and audiology sessions provided to the recipient.
Nevada	Nevada Medicaid covers occupational therapy for children. Prior authorization is required except for the initial evaluation and re-evaluations.	Nevada Medicaid covers occupational therapy for adults. Prior authorization is required except for the initial evaluation and re-evaluations.
New Hampshire	New Hampshire Medicaid covers occupational therapy services for children with limitations. Occupational therapy shall be limited to eighty (80) fifteen-minute units per member per state fiscal year (July 1 – June 30). The eighty (80) units described above may be used for physical therapy, occupational therapy, services for speech, hearing and language disorders, or any combination of these services. Prior authorization is required after limits have been reached.	New Hampshire Medicaid covers occupational therapy services for adults with limitations. Occupational therapy shall be limited to eighty (80) fifteen-minute units per member per state fiscal year (July 1 – June 30). The eighty (80) units described above may be used for physical therapy, occupational therapy, services for speech, hearing and language disorders, or any combination of these services.
New Jersey	New Jersey Medicaid covers occupational therapy for children when provided by OTs employed in a physician’s office.	New Jersey Medicaid covers occupational therapy for adults when provided by OTs employed in a physician’s office. Outpatient rehabilitation benefits are limited to treatment over a period of sixty (60) consecutive business days per incident of illness or injury beginning with the first day of treatment.
New Mexico	New Mexico Medicaid covers occupational therapy for children with prior approval.	New Mexico Medicaid covers occupational therapy for adults with prior approval.
New York	New York Medicaid covers occupational therapy services for children.	New York Medicaid covers occupational therapy services for adults.
North Carolina	North Carolina Medicaid covers occupational therapy services for children with prior authorization.	North Carolina Medicaid covers occupational therapy services for adults with limitations. A total maximum of thirty (30) treatment visits per calendar year combined across occupational and physical therapy habilitative services. A total maximum of thirty (30) treatment visits per calendar year combined across occupational and physical therapy rehabilitative services.
North Dakota	North Dakota covers occupational therapy for children. Occupational therapy evaluations are limited to one (1) per calendar year.	North Dakota covers occupational therapy for adults with limitations. Occupational therapy evaluations are limited to one (1) per calendar year. Occupational therapy is limited to thirty (30) visits per calendar year for members age 21 and over. Prior authorization is required after limits are met.
Ohio	Ohio Medicaid covers occupational therapy for children with limitations. Thirty (30) visits per benefit year. PA required after visit limit is met.	Ohio Medicaid covers occupational therapy for adults with limitations. Thirty (30) visits per benefit year. PA required after visit limit is met.
Oklahoma	Oklahoma Medicaid covers occupational therapy services for children, prior authorization is required after the initial evaluation.	Oklahoma Medicaid only covers occupational therapy for adults in an outpatient hospital setting with prior authorization.
Oregon	Oregon Medicaid covers a total of thirty (30) visits per year of rehabilitative therapy and a total of thirty (30) visits per year of habilitative therapy (physical and occupational therapy) are included on these lines when medically appropriate. Additional visits, not to exceed thirty (30) visits per year of rehabilitative therapy and thirty (30) visits per year of habilitative therapy, may be authorized in cases of a new acute injury, surgery, or other significant change in functional status. Children under age 21 may have additional visits authorized beyond these limits if medically appropriate.	Oregon Medicaid covers a total of thirty (30) visits per year of rehabilitative therapy and a total of thirty (30) visits per year of habilitative therapy (physical and occupational therapy) are included on these lines when medically appropriate. Additional visits, not to exceed thirty (30) visits per year of rehabilitative therapy and thirty (30) visits per year of habilitative therapy, may be authorized in cases of a new acute injury, surgery, or other significant change in functional status.
Pennsylvania	Pennsylvania Medicaid covers occupational therapy services for children.	Pennsylvania Medicaid covers occupational therapy services for adults, may be limited to outpatient hospital setting.
Rhode Island	Rhode Island Medicaid covers occupational therapy services for children.	Rhode Island Medicaid covers occupational therapy services for adults.