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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 Outpatient Therapy

Guidelines for Texas Medicaid coverage of outpatient therapy services.  If the client is enrolled in a managed care plan some of the rules may be different but coverage will be the same.  Members have full access to the material and can email us regarding any billing or compliance issue, please consider joining today if you need additional assistance.  

Updated 8/2/2024

Overview

    • Physical Therapy
    • Occupational Therapy
    • Speech Therapy

Frequency and Duration

    • High Frequency
    • Moderate Frequency
    • Low Frequency
    • Maintenance Level/Prevent Deterioration
    • Requesting Therapy Services

Adult Therapy Services

    • Eligible Providers and Place of Service
    • Prior Authorization and Documentation
    • Procedure Codes and Reimbursement 

Non-Covered Services

    •  Auxiliary Personnel
    • Telehealth Exclusions

Criteria for Coverage

    • Conditions for Coverage
    • Children
    • Adults
    • Criteria for Discontinuation of Therapy

Children’s Therapy Services

    • Eligible Providers and Place of Service
    • Prior Authorization and Documentation
    • Procedure Codes and Reimbursement 

Miscellaneous

    • Co-Treatment
    • Telehealth
    • Group Therapy
    • Change of Therapy Provider










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      Therapy Comply is a healthcare compliance firm that seeks to bring high quality web-based compliance guidance and one-on-one consulting services to small and medium size physical, occupational, and speech therapy practices.

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