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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:

  1. Face-to-face care is medically necessary, based on the patient’s needs.
  2. Patients that will not significantly regress if required face-to-face therapy services are delayed.
  3. Patients for which face-to-face is preferred, but their health may be compromised through personal contact with therapy providers.
  4. 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 providers can be found on Superior's Coronavirus Updates webpage.