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EFFECTIVE 2/1: Physical Therapy, Occupational Therapy, Speech Therapy Services

Date: 01/28/22

Texas Health and Human Services (HHS) is analyzing the clinical and cost effectiveness of COVID-19 Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP and STAR+PLUS Medicare-Medicaid Plan (MMP) telehealth flexibilities to align with House Bill (H.B.) 4 (87th Regular Legislative Session, 2021) requirements. H.B. 4 builds on Senate Bill 670 from the 86th Legislative Session which prohibits Medicaid health plans from denying reimbursement for audio-visual telemedicine or telehealth services solely because the service was delivered remotely. This notice will serve as interim guidance until the policy is codified in the Texas Administrative Code (TAC) through rule and future Texas Medicaid Provider Procedures Manual updates are finalized.

Beginning February 1, 2022, HHS authorizes fee-for-service providers to submit claims for reimbursement for the following physical, occupational, and speech therapies (PT, OT, ST) services delivered by synchronous audio-visual technology.

Synchronous Audio-Visual PT, OT, and ST Evaluation and Treatment

Evaluation, re-evaluation, and treatment for the following procedure codes may be reimbursed when delivered by telehealth as determined clinically appropriate by the rendering therapist and in compliance with each discipline’s rules:

Description of Service

Procedure Codes

Physical Therapy Evaluations- Low, Moderate, and High Complexity

97161, 97162, 97163

Physical Therapy Evaluation- Re-evaluation

97164

Occupational Therapy Evaluation- Low, Moderate, and High Complexity

97165, 97166, 97167

Occupational Therapy Re-evaluation

97168

Therapeutic Exercises

97110

Neuromuscular Re-education

97112

Gait Training

97116

OT or PT Group Therapy

97150

Therapeutic Activities

97530

Self-care/Home Management Training

97535

Community Reintegration- use only with other therapeutic procedure codes

97537

Physical Performance Test or Measurement

97750

Speech Evaluations

92521, 92522, 92523, 92524, 92610

Speech Therapy Re-evaluation

S9152

Services for speech, language, voice, communication, auditory processing disorder treatment

92507

 

Speech Group Therapy

92508

Swallowing/Oral Dysfunction Treatment

92526

Please Note: Providers must use modifier 95 to indicate remote delivery. Providers are reminded to use the required modifiers GP, GO, and GN on all claims for physical, occupational, or speech therapy treatment. Treatment notes should indicate that remote delivery of the service is clinically appropriate per the rendering therapist’s professional judgement.

PT, OT, and ST In-Person Evaluation and Treatment

Specialized evaluations required for the provision of new complex rehabilitation technology, such as power mobility and adaptive seating systems or augmentative communication devices, require the physical presence of the speech-language pathologist, the occupational therapist, or physical therapist and should not be delivered by telehealth.

The following procedure codes will not be reimbursed if delivered by synchronous audio-visual or audio-only technology.

Description of Service

Procedure Codes

Wheelchair assessment and training

97542

Orthotic management and training, initial encounter

97760

Prosthetic training of either or both upper extremity and lower extremity; initial encounter

97761

Orthotic/prosthetic management and/or training, subsequent encounter

97763

Traction

97012

Electrical stimulation (unattended)

97014

Vasopneumatic Device

97016

Paraffin Bath

97018

Whirlpool

97022

Diathermy

97024

Infrared

97026

Ultraviolet

97028

Electrical stimulation

97032

Iontophoresis

97033

Contrast Baths

97034

Ultrasound

97035

Hydrotherapy

97036

Ultrasound

97035

Aquatic therapy

97113

Therapeutic Massage

97124

Manual Therapy

97140

Unlisted Rehabilitation Service

97799

Please Note: For the PT, OT, and ST services listed above, per standards of care, telehealth must be clinically appropriate, safe, and agreed to by the client receiving services or the legally authorized representative (LAR). Telehealth requires consent from the client or the client’s parent or LAR. Verbal consent is permissible and should be documented in the client’s medical record. Telehealth may require participation of a parent or caregiver to assist with the treatment. Providers must be able to defer to the needs of the person receiving services, allowing the mode of service delivery (audio-visual or in-person) to be accessible, person and family-centered, and primarily driven by the person in service’s choice and not provider convenience. Texas Medicaid does not reimburse for PT, OT, or ST delivered via telephone (audio-only).

To see full details, please review the following TMHP Notice: Synchronous Audio-Visual PT, OT, and ST Evaluation and Treatment Telehealth Services and Procedure Codes