Billing Structure Changes for PT, OT and ST Services

Date: 08/25/17

Effective 9/1/17, Texas Medicaid will update therapy benefits for Physical Therapy (PT), Occupational Therapy (OT) and Speech Therapy (ST). In accordance with these changes, Superior will be changing the PT, OT and ST billing structure for providers who serve the following members:

CHIP
STAR
STAR Health
STAR Kids
STAR+PLUS

Providers will be required to bill according to the new billing structure described in the TMHP notification dated 6/30/17 - Physical, Occupational, and Speech Therapy Benefits for All Ages to Change for Texas Medicaid September 1, 2017.

Important Changes for Superior Providers:

On 8/18/17, Superior began to split new OT, PT and ST authorizations into two segments. One segment details the number of units/visits authorized prior to 9/1/17 and the other segment details the number of units/encounters authorized after 9/1/17. These two segments are reflected on the authorization fax and on Superior’s Secure Provider Portal.
On 8/19/17, Superior began altering current authorizations already in place for Home Health OT and PT to reflect timed-based units. A new authorization letter will be faxed to the provider that details the number of visits authorized prior to 9/1/17 and the number of units authorized after 9/1/17. This change is also reflected on Superior’s Secure Provider Portal.
On 9/16/17, Superior will begin altering current authorizations for outpatient ST to reflect untimed encounters. A new authorization letter will be faxed to the provider that details the number of units authorized prior to 9/1/17 and the number of encounters authorized after 9/1/17. This change is also reflected on Superior’s Secure Provider Portal.

Note: Although the outpatient ST authorizations are being corrected after 9/1/17, providers will be required to bill according to the new billing structure beginning 9/1/17.

For questions regarding these changes, please contact Provider Services at 1-877-391-5921, option 3.