Benefit: Outpatient Therapy (physical / respiratory / occupational / speech)

Definition: Physical therapy (PT) addresses the development, improvement or restoration of muscles or relief of muscular pain. PT also is used to relearn body functions or improve a person’s posture to attain maximum movement and relief from pain.

Respiratory therapy is the evaluation and treatment of breathing disorders.

Occupational therapy assists people who have difficulty in achieving a healthy and balanced lifestyle. Occupational therapy gives people the "skills for the job of living" necessary for living meaningful and satisfying lives.

Speech therapy involve the evaluation and treatment of speech-language disorders.

Limits: Medicaid reimbursement is limited to:

• One initial evaluation per recipient, per provider; and
• One re-evaluation every six months per recipient, per provider.

All therapy treatments must have a minimum duration of 15 minutes (one unit) of face-to-face contact between the recipient and the therapist with a maximum of 14 units of service per week. Daily treatment may not exceed 4 units-of-service.

The recipient’s primary care physician must prescribe all therapy treatments.

Speech Therapy Only: A group speech-language therapy treatment is limited to six children. The group must receive a minimum of 30-minutes of therapy.

Exceptions:  None

Co-pays: None

Reform items that can vary: None