SECTION 2 PHYSICAL THERAPY AND OCCUPATIONAL THERAPY SERVICES
Utah Medicaid Provider ManualDivision of Medicaid and Health FinancingPhysical Therapy and Occupational Therapy ServicesUpdated July 2019SECTION 2PHYSICAL THERAPY AND OCCUPATIONAL THERAPY SERVICESAttachment: Physical Therapy and Occupational Therapy Decision TablesTable of Contents1General Information . 21-1 Objectives of Physical and Occupational Therapy. 21-2 General Policy . 22Health Plans . 33Provider Participation and Requirements . 33-1 Credentials. 33-1.1 Physical Therapist . 33-1.2 Occupational Therapist . 34Record Keeping . 45Provider Sanctions . 46Member Eligibility . 47Member Responsibilities . 48Program Coverage . 48-1 Physical therapy and Occupational therapy Services in a Rehabilitation Facility. 48-2 Definitions . 48-3 Covered Services . 58-3.1 Physical Therapy and Occupational Therapy. 58-4 Physical Therapy . 78-4.1 Evaluation . 78-5 Occupational Therapy . 89Non-Covered Services and Limitations . 89-1 Non-Covered Services. 89-2 Limitations . 99-2.1 Physical Therapy Limitations . 99-2.2 Occupational Therapy Limitations . 910Prior Authorization. 1010-1 Prior Authorization Criteria. 1011Billing. 11Page 1 of 14SECTION 2
Utah Medicaid Provider ManualDivision of Medicaid and Health FinancingPhysical Therapy and Occupational Therapy ServicesUpdated July 201911-1 Billing Procedure . 1112Coding . 11References . 111General InformationThe purpose of the physical therapy and occupational therapy programs is to increase the ability of a Medicaidmember, with a temporary or permanent disability, to function at a maximum level through therehabilitative process.Rehabilitation goals must include: Evaluation of the potential of each member Factual statement of the level of functions present Identification of goal(s) that may reasonably be achievedPredetermined space of time and concentration of services that would achieve the goal(s)The Medicaid program is designed to provide services within financial limitations. The objectives of theprogram are to: 1-1Provide scope of serviceGive supplementary informationOutline limitationsGive instructions concerning prior authorizations, billing, and utilization which direct the provider toaccomplish the goals the provider has identified for the memberObjectives of Physical and Occupational TherapyMust include: 1-2Evaluation and identification of the existing problem (not anticipated problem)Evaluation of the potential level of function actually achievableRestoration of functions which have been lost due to accident or illnessEstablishment of functions lacking due to defects of birthTermination or transfer of responsibility for identified procedures to family, guardians, or other caregiversIncreased level of adaptation, independence, or participation in everyday life activities for the memberGeneral PolicyPhysical therapy (PT) and occupational therapy (OT) are optional services. Physical therapy and occupationaltherapy services are mandatory for individuals under the Early Periodic Screening, Diagnosis, and Treatment(EPSDT) program.Physical therapy and occupational therapy as described in this Section are a benefit of the Utah MedicaidProgram. Physical therapy services must be provided by a licensed therapist. Services may be performed by aphysical therapy assistant under the supervision of a physical therapist. Occupational therapy services must beperformed by an occupational therapist or by an occupational therapy assistant.Page 2 of 14SECTION 2
Utah Medicaid Provider ManualDivision of Medicaid and Health FinancingPhysical Therapy and Occupational Therapy ServicesUpdated July 2019This manual is designed to be used in conjunction with other sections of the Utah Medicaid Provider Manual,such as Section I: General Information.2Health PlansThis manual provides information regarding Medicaid policy and procedures for fee-for-service Medicaidbeneficiaries. A Medicaid member enrolled in an MCP (health, behavioral health, or dental plan) must receiveservices through that plan with some exceptions called “carve-out services,” which may be billed directly toMedicaid. Medicaid members enrolled in MCPs are entitled to the same Medicaid benefits as fee-for-servicemembers. However, plans may offer more benefits than the Medicaid scope of benefits explained in this sectionof the provider manual. Contact the Medicaid Member Services hotline at 1(844)238-3091 for furtherinformation.Refer to the provider manual, Section I: General Information, for information regarding MCPs.Medicaid does not process prior authorization requests for services to be provided to a Medicaid beneficiaryenrolled in an MCP when the services are the responsibility of the plan. Providers requesting prior authorizationfor services for a beneficiary enrolled in an MCP will be referred to that plan.Medicaid makes every effort to provide complete and accurate information regarding a beneficiary’s enrollmentin a managed care plan. However, it is the provider’s responsibility to verify eligibility and plan enrollment for abeneficiary before providing services. Therefore, if a Medicaid beneficiary is enrolled in a plan, a fee-forservice claim will not be paid unless the claim is for a “carve-out service.” Eligibility and plan enrollmentinformation for each beneficiary is available to providers from several sources.Eligibility and plan enrollment information for each member is available to providers from these sources: 3The Eligibility Lookup Tool: https://medicaid.utah.gov/eligibilityAccessNow: (800) 662-9651Member Services hotline at (844) 238-3091Provider Participation and RequirementsRefer to Section I: General Information, Chapter 3, Provider Participation and Requirements.3-1Credentials3-1.1Physical TherapistA Medicaid provider who practices physical therapy must meet all of the following: 3-1.2Graduate of a program of physical therapy approved by both the Council on Medical Education of theAmerican Medical Association and the American Physical Therapy Association, or its equivalentLicensed by the State in which the provider practicesEnrolled Provider for the Utah Medicaid ProgramOccupational TherapistA Medicaid provider who practices occupational therapy must meet all of the following: Page 3 of 14Graduate of a program of occupational therapy approved by both the Council on Medical Education ofthe American Medical Association and the Accreditation Council for Occupational therapy (ACOTE),or its equivalentsSECTION 2
Utah Medicaid Provider ManualDivision of Medicaid and Health Financing 4Physical Therapy and Occupational Therapy ServicesUpdated July 2019Licensed by the State in which the provider practicesEnrolled as a provider for the Utah Medicaid ProgramRecord KeepingRefer to Section I: General Information, Chapter 4, Record Keeping.5Provider SanctionsRefer to Section I: General Information, Chapter 5, Provider Sanctions.6Member EligibilityRefer to Section I: General Information, Chapter 6, Member Eligibility, for information about how to verify amember’s eligibility, third party liability, ancillary providers, and member identity protection requirements.Medicaid members who are not enrolled in a managed care plan may receive services from any provider whoaccepts Medicaid and is an enrolled Utah Medicaid provider.7Member ResponsibilitiesFor information on member responsibilities including establishing eligibility and co-payment requirements,refer to Section I: General Information, Chapter 7, Member Responsibilities.8Program CoverageMost procedure codes with accompanying criteria and limitations have been removed from the provider manualand are now found on the Medicaid Coverage and Reimbursement Lookup.8-1Physical therapy and Occupational therapy Services in a Rehabilitation FacilityA Rehabilitation Facility providing therapy services must be enrolled as a Medicaid provider. TheRehabilitation Facility must bill for services using the assigned Medicaid procedure codes. Service claims mustbe submitted from the Medicaid Rehabilitation Facility Provider. Therapists providing services for the agencymay not bill directly for services.8-2DefinitionsDefinitions of terms used in other Medicaid programs are available in Section I: General Information, Chapter1-9 Definitions.Definitions specific to the content of this manual are provided below:Supervision: to act under the requirements of Utah Code Section 58-42a-306 of the Occupational TherapyPractice Act, or Section 58-24b-304 of the Physical Therapy Practice Act.Occupational Therapist: an individual who is licensed as an occupational therapist and meets the practicerequirements in the Utah licensing Occupational Therapy Practice Act Rule, R156-42a.Occupational Therapy: services prescribed by a physician or other licensed practitioner of the healing artswithin the scope of his or her practice under State law and provided to a recipient by or under the direction of aqualified occupational therapist.Occupational Therapy Assistant: a person licensed to practice occupational therapy under the supervision ofPage 4 of 14SECTION 2
Utah Medicaid Provider ManualDivision of Medicaid and Health FinancingPhysical Therapy and Occupational Therapy ServicesUpdated July 2019an occupational therapist.Physical Therapist: an individual who is licensed as a physical therapist and meets the practice requirementsin the Utah licensing Physical Therapy Practice Act Rule, R156-24b.Physical Therapy: services prescribed by a physician or other licensed practitioner of the healing arts withinthe scope of his or her practice under State law and provided to a recipient by or under the direction of aqualified physical therapist.Physical Therapy Assistant: a person licensed to engage in the practice of physical therapy, subject to theprovisions of the Physical Therapy Practice Act, Subsection 58-24b-401(2)(a).Physical Medicine and Rehabilitation: also referred to as Physiatry or Rehabilitation Medicine: a branch ofmedicine concerned with evaluation and treatment of, and coordination of care for, persons withmusculoskeletal injuries, pain syndromes, and/or other physical or cognitive impairments or disabilities. Theprimary focus is on maximal restoration of physical and psychological function, and on alleviation of pain.8-3Covered ServicesRefer to the Coverage and Reimbursement Lookup for additional covered services.8-3.1Physical Therapy and Occupational TherapyTo receive PT or OT services the member must be referred by a doctor of medicine, osteopathy, dentistry, orpodiatry. Therapy services must require a level of proficiency and complexity, and/or the condition of themember must be such that therapy services can only be safely and effectively performed by a therapist.Therapy services must be ordered, in writing, by a physician, physician assistant, or nurse practitioner asauthorized by law.Therapy sessions are limited to one PT session per day and one OT session per day. The evaluation and the firsttreatment may be billed on the same date of service.Therapy services must be: Professionally appropriate according to standards in the fieldUtilize professionally appropriate methods and materialsIn a professionally appropriate environmentProvision of service must be with the expectation: Condition under treatment will improve in a reasonable and predictable timeLength of time and number of treatments will be predicted by Physical Therapy Association GuidelinesService must be reasonable and necessary to the treatment of the member’s conditionTreatment Session: Physical therapy and occupational therapy treatment sessions should be based on theMedicaid member’s specific medical condition and be supported in the treatment plan. A treatment session mayinclude (post payment review): Page 5 of 14EvaluationReassessment of the member’s deficits, progress, rehabilitation potential, plan, and goalsTherapeutic exercise, including neuromuscular reeducation, coordination, and balanceSECTION 2
Utah Medicaid Provider ManualDivision of Medicaid and Health Financing Physical Therapy and Occupational Therapy ServicesUpdated July 2019Therapeutic oral motor, laryngeal, pharyngeal, or breathing exercisesFunctional training in self-care and home managementFunctional training in and modification of environments (home, work, school, or community),including biomechanics and ergonomicsManual therapy techniques, including soft tissue mobilization, joint mobilization, and manuallymphatic drainageAssessment, design, fabrication, application, fitting, and training in assistive technology, adaptivedevices, orthotics, and prosthetic devicesAirway clearance techniquesCompensatory or adaptive communication/swallowing techniques and skillsIntegumentary repair and protection techniquesManagement of positioning, eating, and swallowing to enable/progress safe eating and swallowingElectrotherapeutic modalities, physical agents and mechanical modalities when used in preparation forother skilled treatment proceduresManagement of positioning, eating, and swallowing to enable/progress safe eating and swallowingTraining in assistive technology and adaptive devices, e.g., speech generating devicesTraining in the use of prosthetic devicesTraining of the member, caregivers, and family in home exercises, activity programs, and thedevelopment of a comprehensive maintenance programDocumentation of treatment sessions should include: Date of treatmentSpecific treatment(s) provided that match the procedure codes billed;Total treatment timeThe individual's response to treatmentSkilled ongoing reassessment of the individual's progress toward the goalsAny progress toward the goals in objective, measurable terms using consistent and comparable methodsAny problems or changes to the plan of careName and credentials of the treating clinicianNote: Documentation should be done in accordance with the clinician’s professional organization (e.g., APTAor AOTA) standards.Reevaluation: A reevaluation is indicated when there are new clinical findings, a rapid change in theindividual's status, or failure to respond to physical therapy interventions. There are several routinereassessments that are not considered reevaluations. These include ongoing reassessments that are part of eachskilled treatment session, progress reports, and discharge summaries.Reevaluation is a more comprehensive assessment that includes all the components of the initial evaluation,such as: Page 6 of 14Data collection with objective measurements taken based on appropriate and relevant assessment testsand tools using comparable and consistent methodsMaking a judgment as to whether skilled care is still warrantedOrganizing the composite of current problem areas and deciding a priority/focus of treatmentIdentifying the appropriate intervention(s) for new or ongoing goal achievementModification of intervention(s)Revision in plan of care if neededCorrelation to meaningful change in functionSECTION 2
Utah Medicaid Provider ManualDivision of Medicaid and Health Financing Physical Therapy and Occupational Therapy ServicesUpdated July 2019Deciphering effectiveness of intervention(s)Documentation of Reevaluation should include ALL the components of the initial evaluation, in addition to: Discussion regarding the appropriateness of continuing skilled therapyList of current problems and deciding a priority/focus of treatmentIdentifying the appropriate intervention(s) for new or ongoing goal achievementModification of interventions(s)Revision of plan of care, as neededCorrelation to meaningful change in functionDeciphering effectiveness of intervention(s)Note: Documentation should be done in accordance with the clini
Physical Therapy Assistant: a person licensed to engage in the practice of physical therapy, subject to the provisions of the Physical Therapy Practice Act, Subsection 58-24b-401(2)(a). Physical Medicine and Rehabilitation: also referred to as Physiatry or Rehabilitation Medicine: a branch of
Occupational Therapy Occupational Therapy Information 29 Occupational Therapy Programs 30 Occupational Therapy Articulation Agreements 31 Occupational Therapy Prerequisites 33 Physical Therapy Physical Therapy Information 35 Physical Therapy Programs and Prerequisites 36 Physical Therapy Articulation Agreements 37 Physical Therapy vs .
Nevada Physical Therapy Board Mission Statement Mission The mission of the Nevada Physical Therapy Board is to protect the safety and well-being of the public consumer of physical therapy. Who We License The Nevada Physical Therapy Board licenses physical therapists and physical thera-pist assistants.
Doctorate of Physical Therapy, Arcadia University - 2016 Masters of Health Sciences degree in Physical Therapy, Krannert School of Physical Therapy in Indianapolis -1995 Bachelor of Science Degree in Physical Therapy, Northwestern University -1987 Bachelor of Arts Degree, Southern Illinois University - 1986
in the history of family therapy. They include Bowen Natural Systems Theory, contex-tual therapy, Virginia Satir’s Growth Model, brief therapy of the Mental Research Insti-tute, strategic family therapy, Milan Systemic Family Therapy, structural family therapy, solution-focused brief therapy, and narrative therapy.
Physical Therapy Aide 4 Unit 14 Lesson 14 introduces therapeutic exercises, assisting with ambulation and gait training, various therapy agents and modalities used in physical therapy, and specialized clinical procedures. This lesson also covers job hunting skills for the physical therapy ai
(2008). Occupational therapy practice framework: Domain and process (2nd ed.). American Journal of Occupational Therapy, 62, 625-683. American Occupational Therapy Association. (2013). Guidelines for Documentation of Occupational Therapy. American Journal of Occupational Therapy, 67 (6), S32-S38. American Physical Therapy Association. (2009).
Physical Therapy Aide A physical therapy aide most often works under the direction of a physical therapist and/or physical therapy assistant. Physical therapy aide jobs often include keeping the treatment area clean and well organized, as well as to help escort patients in wheel
preferably automotive Experience of working in Quality Assurance Six Sigma/Lean skills Experience of dealing with customers and suppliers Example roles this job description may cover: Quality Manager . Author: Elisa Created Date: 12/14/2015 11:27:13 AM .
