Provider Alert! 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 visit the TMHP website to review 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:

• For therapy authorizations with approved dates of service spanning the September 1, 2017 transition date, Texas Children’s Health Plan has created a revised authorization in our system that reflects the new billing structure using the same authorization number.
• For all therapy requests that were submitted prior to September 1, 2017, the revised authorization will start on September 1 and cover through the end of the authorized period. Providers will not need to change their authorization reference number for claims submission.
• 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.

Texas Children’s Health Plan will continue to prefer the Texas Standard Prior Authorization form available on our website for therapy requests. This form can be found at http://www.texaschildrenshealthplan.org/sites/default/files/pdf/20150410_Standard%20Prior%20Auth%20Form.pdf