Upcoming Webinars

  • No upcoming events

Site Updates


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

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.  

Key Definitions

    • Physical Therapy
    • Occupational Therapy
    • Speech - Language Pathology
    • Acute Services
    • Chronic Services

Children’s Services

    • Acute PT, OT, and ST Services
    • Chronic Services
    • Developmental Delay Criteria
    • Authorization Requirements for PT, OT, and ST Services
    • Requests for Recertification—Acute Therapy Services
    • Requests for Recertification - Chronic Therapy Services
    • PT, OT, and ST Therapy Procedure Codes

Frequency and Duration Criteria

    • High Frequency
    • Moderate Frequency
    • Low Frequency
    • Maintenance and Prevention


    • Co-Treatment
    • Group Therapy

Services Not Covered

Providers and Settings

    • Eligible providers
    • Who can provide therapy services to children?
    • Who can provide therapy services to adults?
    • What are the criteria for providing therapy at the client’s home?
    • What is the role of assistants in providing therapy services?
    • Aides

    Adult Services

      • Adult Physical and Occupational Services
      • Authorization Requirements for Outpatient and Home Health —PT, OT, and SLP Services
      • Requests for Recertification - Up to an Additional Sixty (60) days for Acute Services
      • PT, OT, and SLP Procedure Codes


      • Written and Verbal Orders
      • Treatment Plan
      • Progress Summary
      • Treatment Note

          About Us

          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.

          Learn More 

          Join Us

          Join today as either a monthly or a yearly member and enjoy full access to the site and a significant discount to our live and recorded webinars.  Members also have access to compliance and billing support.

          Join Today 

          Find Us

          Powered by Wild Apricot Membership Software