Upcoming Webinars 


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.

Log in

Log in

New York Medicaid Outpatient PT and OT

Qualified Practitioners

  • Who is qualified to provided therapy services?
  • Can assistants provide therapy services to Medicaid patients?
  • Can aides be used to provide services?
  • Is an order required for therapy services?
  • Who must issue the order?

Covered Services

  • What are the required criteria for therapy services?
  • How is Long Term Therapy defined?
  • How is Restorative Therapy defined?
  • Is there a limit on the number of therapy visits?
  • Is there an exception to the limit?

Prior Authorization

  • When is prior authorization required?
  • When does the PA request need to be made?
  • Is there a limit to the number of requests that can be made per beneficiary?
  • When is prior authorization not required?
  • Required Modifiers

Documentation Requirements

    • Evaluation
    • Reevaluation
    • Treatment Session

Powered by Wild Apricot Membership Software