Upcoming Webinars 

Disclaimer

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.

Menu
Log in


Log in

Non-Covered Therapy Services 

Therapy services not covered by the Texas Medicaid Program:

  • Speech therapy provided in the home to adult clients who are 21 years of age and older
  • Therapy services that are provided after the client has reached the maximum level of improvement or is now functioning within normal limits
  • Massage therapy that is the sole therapy or is not part of a therapeutic plan of care to address an acute condition
  • Separate reimbursement for VitalStim therapy for dysphagia. VitalStim must be a component of a comprehensive feeding treatment plan to be considered a benefit.
  • Repetitive therapy services that are designed to maintain function once the maximum level of improvement has been reached, which no longer require the skills of a therapist to provide or oversee
  • Therapy services related to activities for the general good and welfare of clients who are not considered medically necessary because they do not require the skills of a therapist, such as:
    • General exercises to promote overall fitness and flexibility or improve athletic performance
    • Activities to provide diversion or general motivation
    • Supervised exercise for weight loss
  • Treatment solely for the instruction of other agency or professional personnel in the client’s physical, occupational or speech therapy program
  • Emotional support, adjustment to extended hospitalization and/or disability, and behavioral readjustment
  • Therapy prescribed primarily as an adjunct to psychotherapy
  • Treatments not supported by medically peer-reviewed literature, including but not limited to investigational treatments such as sensory integration, vestibular rehabilitation for the treatment of attention deficit hyperactivity disorder, anodyne therapy, craniosacral therapy, interactive metronome therapy, cranial electro stimulation, low-energy neuro-feedback, and the Wilbarger brushing protocol.
  • Therapy not expected to result in practical functional improvements in the client’s level of functioning
  • Treatments that do not require the skills of a licensed therapist to perform in the absence of complicating factors (i.e., massage, general range of motion exercises, repetitive gait, activities and exercises that can be practiced by the client on their own or with a responsible adult’s assistance)
  • The therapy requested is for general conditioning or fitness, or for educational, recreational or work-related activities that do not require the skills of a therapist
  • Equipment and supplies used during therapy visits are not reimbursed separately; they are considered part of the therapy services provided
  • Therapy services provided by a licensed therapist who is the client’s responsible adult (e.g., biological, adoptive, or foster parents, guardians, court-appointed managing conservators, other family members by birth or marriage)

Reference

Texas Medicaid Provider Procedures Manual

Physical Therapy, Occupational Therapy, and Speech Therapy Handbook

June 2020




Powered by Wild Apricot Membership Software