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Texas Medicaid Coverage of Therapy Services for Adults

Physical therapy (PT), occupational therapy (OT), and speech therapy (SLP) services are benefits of Texas Medicaid for the medically necessary short term treatment of an acute medical condition or an acute exacerbation of a chronic medical condition for clients who are 21 years of age and older.

Adult Physical, Occupational and Speech Therapy Services

  • Requirements for Treatment
  • Adult Acute Therapy Place of Service

Authorization Requirements for Outpatient and Home Health Services

  • Initial Evaluation and Considerations for Prior Authorization for Treatment
  • Prior Authorization Requests
  • Documentation for Initial Therapy Request
  • Required Contents of the Treatment Plan
  • Written and Verbal Orders

Requests for Recertification - Up to an Additional Sixty (60) days for Acute Services

  •  When to Request Recertification
  •  Recertification Documentation
  •  Progress Summary
  •  Requests for Revisions to Existing Prior Authorization or Recertification

PT, OT, and SLP Procedure Codes

    • PT and OT Treatment Procedure Codes
    • Untimed PT and OT Treatment Procedure Codes
    • SLP Treatment Procedure Codes
    • PT, OT, and SLP Evaluation and Re-evaluation Procedure Codes
    • PT, OT, and SLP Reimbursement Guidelines

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