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Elizabeth M. Whitehorn, Director

Provider Notice issued 11/01/2024

 

To: Enrolled Physical Therapists; Occupational Therapists; and Speech Therapists
​Date November 1, 2024
​Re:
 Policy and Billing Changes for Physical, Occupational, and Speech Therapies 

This notice informs therapists of policy and billing changes for physical therapy (PT), occupational therapy (OT), and speech therapy (ST) services. These changes apply to the Medicaid fee-for-service (FFS) program and the managed care organizations (MCOs) and are effective with service dates beginning December 1, 2024.

Effective December 1, 2024, the Department of Healthcare and Family Services (HFS) will make the following changes:

·         Increase the maximum units allowed for a therapy evaluation for adults to eight (8) units per day, from the current four (4) units. The maximum allowable units for a therapy evaluation for children is already set to eight (8) units per day.

·         Increase all other outpatient PT, OT, and ST services to a maximum of eight (8) units for each per day.

·         Allow a therapy service to be billable on the same date as a therapy evaluation.  HFS still requires a treatment plan to be in place prior to the initial therapy service, and therapy services (except for speech therapy for children through age 20) will still require prior approval.

The Therapy Fee Schedule has been updated. Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.

 

 

Kelly Cunningham, Administrator
Division of Medical Programs