Occupational, Physical and Speech-Language Therapy: Updated Codes, Classifications for Telehealth
Date: 04/20/20
Note: Please view UPDATED: Occupational, Physical and Speech-Language Therapy: Updated Codes, Classifications for Telehealth for an updated end date for this guidance.
Effective March 27, 2020, Superior HealthPlan implemented an expansion of Occupational, Physical and Speech-Language Therapy (OT, PT, ST) benefits through synchronous (video) telehealth service delivery for re-evaluation and treatment services.
Effective April 20, 2020, Superior HealthPlan is amending the expansion to include the Current Procedural Terminology (CPT) codes below. The expanded benefit will terminate May 13, 2020, coinciding with the end of Governor Greg Abbott’s current disaster declaration regarding COVID-19.
Effective May 6, 2020, Superior HealthPlan is amending the end date of the expansion to May 31, 2020 per HHSC guidance. HHSC guidance may be found on the TMHP website: Date of Service Extension for Telemedicine (Physician-Delivered) and Telehealth (Non-Physician-Delivered) Services.
Please note: If there is a suspension of the telehealth therapy expanded benefit, Superior will notify providers in advance of May 31, 2020.
Provider Type | CPT Code® | Description |
|---|---|---|
Physical Therapy | 97161 | Physical therapy evaluation - low complexity |
Physical Therapy | 97162 | Physical therapy evaluation - moderate complexity |
Physical Therapy | 97163 | Physical therapy evaluation - high complexity |
Physical Therapy | 97164 | Physical therapy re-evaluation |
Physical Therapy | 97110 | Therapeutic procedure, one or more areas, each 15 minutes |
Physical Therapy | 97116 | Gait training |
Physical Therapy | 97530 | Therapeutic activities, one-to-one patient contact, each 15 minutes |
Physical Therapy | 97112 | Therapeutic procedure, one or more areas, each 15 minutes |
Physical Therapy | 97535 | Self-care/home management training, each 15 minutes |
Occupational Therapy | 97165 | Occupational therapy evaluation - low complexity |
Occupational Therapy | 97166 | Occupational therapy evaluation - moderate complexity |
Occupational Therapy | 97167 | Occupational therapy evaluation - high complexity |
Occupational Therapy | 97168 | Occupational therapy re-evaluation |
Occupational Therapy | 97110 | Therapeutic procedure, one or more areas, each 15 minutes |
Occupational Therapy | 97530 | Therapeutic activities, one-to-one patient contact, each 15 minutes |
Occupational Therapy | 97112 | Therapeutic procedure, one or more areas, each 15 minutes |
Occupational Therapy | 97535 | Self-care/home management training, each 15 minutes |
Speech Therapy | 92507 | Treatment of speech, language, voice, communication and/or auditory processing disorder |
Speech Therapy | 92521 | Evaluation of speech fluency |
Speech Therapy | 92522 | Evaluation of speech sound production |
Speech Therapy | 92523 | Evaluation of speech sound production |
Speech Therapy | 92524 | Behavioral and qualitative analysis of voice and resonance |
Speech Therapy | 92526 | Treatment of swallowing dysfunction and/or oral function for feeding |
Speech Therapy | 92610 | Evaluation of oral and pharyngeal swallowing function |
Speech Therapy | 96105 | Assessment of Aphasia and Cognitive Performance Testing |
Patient screening is required to determine the potential safety and benefits of telehealth service delivery. Consideration of the level of physical assistance, supplies and/or equipment required, the patient’s level of compliance and the patient’s distant environment are required. Therapy providers are encouraged to stratify patients into the following categories:
- Face-to-face care is medically necessary, based on the patient’s needs.
- Patients that will not significantly regress if required face-to-face therapy services are delayed.
- Patients for which face-to-face is preferred, but their health may be compromised through personal contact with therapy providers.
- Telehealth therapy provides the same level of safety and quality of care delivered through face-to-face care.
If the provider’s screening confirms that telehealth therapy would provide a full and complete evaluation, re-evaluation and/or treatment session for therapy, and the requested frequency, scope and duration of therapy is determined to be medically necessary through Superior’s review of the request for prior authorization, telehealth therapy services will be eligible for reimbursement.
For more information regarding telehealth service requirements delivery, please refer to Texas Medicaid & Healthcare Partnership (TMHP)’s Telecommunication Services Handbook. Additional COVID-19 updates for Superior providers can be found on the Foster Care Texas Coronavirus Updates webpage.