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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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West Virginia Medicaid Coverage of Therapy Services

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

West Virginia Medicaid covers physical therapy services for children with limitations.

Services are limited to a combined total of twenty (20) visits per event of physical therapy, occupational therapy, osteopathic manipulation, Chronic Pain Management programs, and chiropractic treatment. All services beyond the initial twenty (20) treatments require prior authorization.

Initial evaluations are limited to one (1) per year.  Reevaluations are limited to two per (2) year.

West Virginia Medicaid covers physical therapy services for adults with limitations.

Services are limited to a combined total of twenty (20) visits per event of physical therapy, occupational therapy, osteopathic manipulation, Chronic Pain Management programs, and chiropractic treatment. All services beyond the initial twenty (20) treatments require prior authorization.

Initial evaluations are limited to one (1) per year.  Reevaluations are limited to two per (2) year.

Occupational Therapy

West Virginia Medicaid covers occupational therapy services for children with limitations.

Services are limited to a combined total of twenty (20) visits per event of physical therapy, occupational therapy, osteopathic manipulation, Chronic Pain Management programs, and chiropractic treatment. All services beyond the initial twenty (20) treatments require prior authorization.

Initial evaluations are limited to one (1) per year.  Reevaluations are limited to two per (2) year.

West Virginia Medicaid covers occupational therapy services for adults with limitations.

Services are limited to a combined total of twenty (20) visits per event of physical therapy, occupational therapy, osteopathic manipulation, Chronic Pain Management programs, and chiropractic treatment. All services beyond the initial twenty (20) treatments require prior authorization.

Initial evaluations are limited to one (1) per year.  Reevaluations are limited to two per (2) year.

Speech Therapy

West Virginia Medicaid covers speech-language therapy services are covered for Medicaid members up to 21 years of age.

For West Virginia members 21 years of age and older, speech-language therapy is limited to one evaluation for medical/surgical conditions which include, but are not limited to:  cerebral vascular accident (CVA), tracheotomy, tracheostomy, laryngectomy, traumatic brain injury (TBI), nerve injuries (e.g., 5th, 7th – 12th), amyotrophic lateral sclerosis (ALS), cerebral palsy, and dysarthria. 

Speech language therapy requires prior authorization beyond the initial evaluation.

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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