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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


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