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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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Texas Medicaid School Based Services

Medicaid services provided by school districts in Texas to Medicaid-eligible students are known as SHARS. The oversight of SHARS is a cooperative effort between the Texas Education Agency (TEA) and HHSC. SHARS allows local school districts, including public charter schools, to obtain Medicaid reimbursement for certain health-related services provided to students in special education under IDEA that are documented in a student’s Individualized Education Program (IEP).

    These services must be provided by qualified personnel who are under contract with or employed by the school district.

    Prior authorization is not required for SHARS services.

    Physician Prescription

    A physician prescription is required before PT or OT services may be reimbursed under SHARS. ST services require either a physician prescription or a referral from a licensed SLP before the ST services may be reimbursed under the SHARS program. The school district must maintain the prescription or referral. The prescription or referral must relate directly to specific services listed in the IEP. If a change is made to a service on the IEP that requires a prescription or referral, the prescription or referral must be revised accordingly.

    The expiration date for the physician prescription is the earlier of either the physician’s designated expiration date on the prescription or three years, in accordance with the IDEA three-year re-evaluation requirement.

    Eligibility and Verification

    Occupational Therapy

      • Referral
      • Providers
      • Services
      • Evaluation
      • Session Notes
      • Reimbursement

    Occupational Therapy through Telehealth

      • Eligible Providers
      • SHARS Telehealth Services
      • Prior Authorization Requirements
      • Reimbursement

    Physical Therapy 

      • Referral
      • Providers
      • Services
      • Evaluation
      • Session Notes
      • Reimbursement

    Documentation


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