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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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Low Frequency 

Therapy provided one time per week or every other week may be considered when the documentation shows one or more of the following:

  • The patient is making progress toward the patient’s goals, but the progress has slowed, or documentation shows the patient is at risk of deterioration due to the patient’s development or medical condition.
  • The licensed therapist is required to adjust the patient’s therapy plan and home program weekly to every other week based on the patient’s progress.
  • Every other week therapy is supported for patients whose medical condition is stable, they are making progress, and it is anticipated the patient will not regress with every other week therapy.

Citation

Texas Medicaid Provider Manual

Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook

August 2019

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