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