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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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Virginia Medicaid Coverage of Therapy Services

Virginia Medicaid coverage and prior authorization information for therapy services.  See our Virginia 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

Virginia Medicaid covers physical therapy services for children provided in outpatient settings of acute and rehabilitation hospitals, rehabilitation agencies, nursing facilities, or home health agencies shall include authorization for up to five (5) allowed visits, which do not require preceding service authorization, by each ordered rehabilitative service annually.

Prior authorization is required after five (5) visits.

Virginia Medicaid covers physical therapy services for adults provided in outpatient settings of acute and rehabilitation hospitals, rehabilitation agencies, nursing facilities, or home health agencies shall include authorization for up to five (5) allowed visits, which do not require preceding service authorization, by each ordered rehabilitative service annually.

Prior authorization is required after five (5) visits.

Occupational Therapy

Virginia Medicaid covers occupational therapy services for children provided in outpatient settings of acute and rehabilitation hospitals, rehabilitation agencies, nursing facilities, or home health agencies shall include authorization for up to five (5) allowed visits, which do not require preceding service authorization, by each ordered rehabilitative service annually.

Prior authorization is required after five (5) visits.

Virginia Medicaid covers occupational therapy services for adults provided in outpatient settings of acute and rehabilitation hospitals, rehabilitation agencies, nursing facilities, or home health agencies shall include authorization for up to five (5) allowed visits, which do not require preceding service authorization, by each ordered rehabilitative service annually.

Prior authorization is required after five (5) visits.

Speech Therapy

Virginia Medicaid covers speech therapy services for children provided in outpatient settings of acute and rehabilitation hospitals, rehabilitation agencies, nursing facilities, or home health agencies shall include authorization for up to five (5) allowed visits, which do not require preceding service authorization, by each ordered rehabilitative service annually.

Prior authorization is required after five (5) visits.

Virginia Medicaid covers speech therapy services for adults provided in outpatient settings of acute and rehabilitation hospitals, rehabilitation agencies, nursing facilities, or home health agencies shall include authorization for up to five (5) allowed visits, which do not require preceding service authorization, by each ordered rehabilitative service annually.

Prior authorization is required after five (5) visits.

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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