Provider Alert! Changes to Physical, Occupational, and Speech Therapy Benefits for All Ages

Subject: Changes to Physical, Occupational, and Speech Therapy Benefits for All Ages

Effective for dates of service on or after September 1, 2017, physical therapy (PT),
occupational therapy (OT), and speech therapy (ST) benefits for all ages will change for
Texas Medicaid.

Please review http://www.tmhp.com/News_Items/2017/06-June/06-30-
17%20Physical,%20Occupational,%20and%20Speech%20Therapy%20Benefits%20for%20All%20Ages%20
to%20Change%20for%20Texas%20Medicai.pdf for changes to this medical benefit policy that applies to
the following:

• Billing structure changes for PT, OT, and ST services
• Procedure codes end-dating August 31, 2017
• Required modifiers
• Claims filing changes
• Clarification to benefits

Providers may refer to the current Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook (TMPPM), section 7.2.1. “Method for Counting Minutes for Timed Procedure Codes in 15-Minute Units,” for additional information on how to calculate billing 15-minute units.

Providers must list all relevant procedure codes on the Texas Medicaid Physical, Occupational, or Speech Therapy (PT, OT, ST) Prior Authorization Form when requesting prior authorization for therapy services.

Prior Authorization Changes

Changes to TCHP Prior Authorizations for PT, OT, and ST services:

• TCHP will update existing prior authorizations that span the effective date of September 1, 2017
  in our system. The case reference number (prior authorization number) will not change for
  updated authorizations that will be active on or after September 1, 2017.
• Starting August 1, 2017, new requests for therapy authorizations will begin processing according
  to the new billing structure for dates of service on or after September 1, 2017.
• Dates of service prior to September 1, 2017 will be authorized using the current billing structure.
  All requests for therapy authorizations for dates of service on or after September 1, 2017 should
  be submitted according to the new billing structure.
• TCHP will continue to prefer the Texas Standard Prior Authorization form available on our
  website for Therapy requests.

http://www.texaschildrenshealthplan.org/sites/default/files/pdf/20150410_Standard%20Prior%
20Auth%20Form.pdf