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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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Maintenance Level/Prevent Deterioration

For patients who are 20 years of age and younger only, this frequency level (e.g., every other week, monthly, every 3 months) is used when the therapy plan changes very slowly, the home program is at a level that may be managed by the patient or the responsible adult, or the therapy plan requires infrequent updates by the skilled therapist. A maintenance level or preventive level of therapy services may be considered when a patient requires skilled therapy for ongoing periodic assessments and consultations and the patient meets one of the following criteria:

    • Progress has slowed or stopped, but documentation supports that ongoing skilled therapy is required to maintain the progress made or prevent deterioration.
    • The submitted documentation shows that the patient may be making limited progress toward goals or that goal attainment is extremely slow.
    • Factors are identified that inhibit the patient’s ability to achieve established goals (e.g., the patient cannot participate in therapy sessions due to behavior issues or issues with anxiety).
    • Documentation shows the patient and the responsible adult have a continuing need for education, a periodic adjustment of the home program, or regular modification of equipment to meet the patient’s needs.

Citation

Texas Medicaid Provider Manual

Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook

August 2019

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