Physical, Occupational, and Speech Therapy Services
(TX.CP.MP.549)
| Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), and CHIP
| Policy updates include:
- Removed section I.A. regarding member physical exam
- Clarifying language of “documentation of” throughout policy
- Removed section I.D. “There is a expectation that within a reasonable and medically predictable period of time the treatment will produce clinically significant and measurable improvement in the member’s level of functioning and prevent or delay further decline”
- Removed section II “Not medically necessary”
- Added V.D Developmental Delay header C to clarify testing (1-2), the types of testing and results (sections i-iv) remained unchanged
- Added to Section IX B 4 d and IX C 4 c note “Documentation may include current standardized assessment scores, norm-referenced testing, age equivalents, a percentage of functional delay, criterion-referenced scores or other objective information as appropriate for the member’s condition or impairment and specific to the therapy provided”
- Updated language to apply current ASHA standards in Section IX, B, 4, n, iii “If swallowing/feeding concerns and/or signs or symptoms of aspiration are identified, a complete, objective clinical-bedside swallow evaluation (performed by the requesting therapist) is expected, as per ASHA standards for both pediatric and adult dysphagia. In addition, if an objective-clinical-bedside swallow evaluation yields signs, symptoms or concern for aspiration and/or risk thereof, a statement indicating that a referral has been made to the prescribing provider to consider an instrumental swallow study should be included. The member’s language, speech, hearing, voice and fluency skills must also be addressed in the assessment via a screen or objective testing”
- Added clarifying language to IX, C, 4, d, ii “A full review of the documented therapy history may be conducted if the record reflects lack of progress, repetitive goals, or does not support skilled services that are appropriate or functionally beneficial. Note: a member’s diagnoses/conditions at the time of the prior assessment and goal development would not be considered a barrier to progress”
- Updated code list added 92597, 92607, 92608, 92609 and removed 92606, 92613, 92615, 92617, 92526, 97010, 97139, 97533, 97545,97546, 97755, G0151, G0152, G0157, G0159 G0160, G0161, S9090, G0283, S8948, 20560, 20561, 0791T, 92506
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