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High Frequency 

High frequency (3 times per week) can only be considered for a limited duration (approximately 4 weeks or less) or as otherwise requested by the prescribing provider with documentation of medical need to achieve an identified new skill or recover function lost due to surgery, illness, trauma, acute medical condition, or acute exacerbation of a medical condition, with well-defined specific, achievable goals within the intensive period requested.

Therapy provided three times a week may be considered for 2 or more of these exceptional situations:

  • The patient has a medical condition that is rapidly changing.
  • The patient has a potential for rapid progress (e.g., excellent prognosis for skill acquisition) or rapid decline or loss of functional skill (e.g., serious illness, recent surgery).
  • The patient’s therapy plan and home program require frequent modification by the licensed therapist.

On a case-by-case basis, a high frequency requested for a short-term period (4 weeks or less) which does not meet the above criteria may be considered with all of the following documentation:

  • Letter of medical need from the prescribing provider documenting the patient’s rehabilitation potential for achieving the goals identified,
  • Therapy summary documenting all of the following:
  • Purpose of the high frequency requested (e.g., close to achieving a milestone)
  • Identification of the functional skill which will be achieved with high frequency therapy
  • Specific measurable goals related to the high frequency requested and the expected date the goal will be achieved.

Citation

Texas Medicaid Provider Manual

Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook

August 2019

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