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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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Utah Medicaid Coverage of Therapy Services

Utah Medicaid coverage and prior authorization information for therapy services.  See our Utah Medicaid Outpatient Therapy page for more detailed information.  Members can email me with any questions or schedule a call about any Medicaid coverage, billing or compliance issues.  

Children

Adults

Physical Therapy

Utah Medicaid covers physical therapy services for children are limited to twenty (20) therapy sessions, per member, per calendar year, when criteria are met. (The evaluation is NOT counted as one of the twenty (20) sessions.) Prior authorization is required for more than twenty (20) sessions per calendar year.

Physical therapy services for maintenance are limited to EPSDT program eligible members and to one (1) PT and one (1) OT maintenance visit per month for care-giver training, to provide routine, repetitive or reinforced procedures of routine care in the residence.

Utah Medicaid covers physical therapy services for adult members are limited to twenty (20) therapy sessions, per member, per calendar year, when criteria are met. (The evaluation is not counted as one of the twenty (20) sessions.)

Prior authorization is required for more than twenty (20) sessions per calendar year.

Occupational Therapy

Utah Medicaid covers occupational therapy services for children are limited to twenty (20) therapy sessions, per member, per calendar year, when criteria are met. (The evaluation is not counted as one of the twenty (20) sessions.) Prior authorization is required for more than twenty (20) sessions per calendar year.

Occupational therapy services for maintenance are limited to EPSDT program eligible members and to one (1) PT and one (1) OT maintenance visit per month for care-giver training, to provide routine, repetitive or reinforced procedures of routine care in the residence.

Utah Medicaid covers occupational therapy services for adult members are limited to twenty (20) therapy sessions, per member, per calendar year, when criteria are met. (The evaluation is not counted as one of the twenty (20) sessions.)

Prior authorization is required for more than twenty (20) sessions per calendar year.

Speech Therapy

Utah Medicaid covers speech therapy services for children, limited to a combined total of twenty-four (24) sessions in a six (6) month period.

Prior authorization is required after limits have been reached.

Utah Medicaid covers speech therapy for adults with limits depending on the condition

Pregnant Members: Fifteen (15) annual visits.

Speech therapy for cognitive purposes is limited to fifteen (15) visits per twelve (12) month period.

Speech therapy for the use of a speech generating device is limited to eight (8) visits per twelve (12) month period.

Treatment for swallowing dysfunction and/or oral function is limited to ten (10) per 180-day period. 

About Us

Zachary Edgar JD, LLM is the managing partner for Therapy Comply.  Zachary is a healthcare attorney that specializes in federal and state healthcare regulatory issues particularly for physical, occupational, and speech therapy practices.  

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