Alabama PT, OT and SLP guide

For OT, PT and SLP clinics in Alabama: three state boards license the disciplines; a physical therapist with a doctorate, or a master’s degree and 10 years of practice, may treat without a referral, within the statute’s conditions; Alabama Medicaid covers children’s therapy under EPSDT and adults within its own rules; and telehealth follows the patient’s location.⁠^1,2,3,4,5

Who licenses OTs, PTs and SLPs in Alabama?

Three state boards license the three disciplines in Alabama, and each publishes its own licensing law, rules, renewal cycle and continuing-education requirement.⁠^1,6,7 A clinic that employs more than one discipline keeps three registers, not one.

Physical therapists and physical therapist assistants answer to the Alabama Board of Physical Therapy.⁠^{1,42,43,44,45,46,47,48,49,50,51,52} Occupational therapists and occupational therapy assistants answer to the Alabama State Board of Occupational Therapy.⁠^{6,53,54,55,56,57,58,59,60} Speech-language pathologists answer to the Alabama Board of Examiners for Speech-Language Pathology and Audiology (ABESPA).⁠^{7,61,62,63,64,65,66,67,68,69} OTs and OTAs are licensed by the Alabama State Board of Occupational Therapy, a five-member board.⁠^{6,53,54,55,56,57,58,59,60} The board licenses both speech-language pathologists and audiologists, granting licensure in either field.⁠^{7,61,62,63,64,65,66,67,68,69} The licensure act does not restrict a person who holds a current Alabama Department of Education credential as a speech or hearing specialist and performs services only within the organization that employs the person.⁠^{7,61,62,63,64,65,66,67,68,69} A license is a state authorization; a national certification (NBCOT for occupational therapy, the ASHA certificate for speech-language pathology, the NPTE for physical therapy) is a different thing and does not replace it. Compact privileges for practitioners licensed elsewhere are covered under telehealth below.

What does an Alabama license renewal require?

Each board sets its own cycle and hours, listed in the table above, and the register template at the end of this page tracks them per clinician.⁠^1,6,7 A renewal missed is a lapse, and the board’s own rules say what a lapsed licensee may and may not do; the clinic reads those rules before a clinician’s renewal date passes, not after.

Can a patient see an Alabama PT, OT or SLP without a referral?

State law answers this discipline by discipline, and a payer may still require a referral the law does not. For physical therapy, the licensing law bars a physical therapist from treating without a referral from a physical therapy referrer (a physician, dentist, chiropractor, physician assistant or nurse practitioner under the act’s conditions) unless the therapist holds a doctorate in physical therapy, or a master’s degree with 10 years of clinical practice experience, and is licensed in Alabama after passing the national examination; such a therapist may treat without a referral, but a patient with no beneficial response within 30 calendar days or 11 visits, whichever comes first, must be referred to a health care provider.⁠^{2,8,9,10,11,12,13,14,15,16} A qualifying physical therapist may screen, evaluate, set a plan of care and begin treatment without a referral for non-work-related conditions, and a patient paying cash has direct access without restriction. The 30-day or 11-visit limit does not apply to a child with a diagnosed developmental disability under a plan of care developed by a physical therapy referrer, to home health and nursing home patients under their plans of care, to a recently diagnosed chronic condition after the referrer is informed, or to wellness activities. Before treating without a referral, the physical therapist gives the patient a written disclosure that the assessment is not a medical diagnosis and is not based on imaging. A physical therapist may not treat a patient who had a concussion within the previous 45 days without a physician’s clearance, or a patient who had surgery for a diagnosed condition within the previous 90 days without a referral. A physical therapist who treats without a referral must carry professional liability insurance at the minimum limits the act sets. The direct-access section does not require any health benefit plan to cover or pay for physical therapy without a referral. Alabama Medicaid, as a payer, covers physical therapy only when a physician prescribes it, and not when it is provided in a physician’s office.⁠^{2,8,9,10,11,12,13,14,15,16} For occupational therapy, the licensing law bars starting an occupational therapy treatment program without the referral of a licensed physician, chiropractor, optometrist, physician assistant, nurse practitioner, psychologist or dentist who establishes a diagnosis; a person in long-term occupational therapy must be reevaluated by one of them at least annually, and wellness or community services not related to injury, disease or illness, and OTs employed by state agencies or by public schools and colleges for students’ educationally related needs, are exempt from the referral requirement.⁠^70,71,72,73 Alabama Medicaid, as a payer, covers occupational therapy for a child when a physician orders it for a condition identified during an EPSDT screening.⁠^70,71,72,73 For speech-language pathology, the licensure act requires a license to practice speech-language pathology in Alabama and defines the field as measurement, testing, evaluation, counseling, instruction, habilitation or rehabilitation for disorders of speech, voice or language.⁠^74,75,76 Alabama Medicaid, as a payer, requires a physician’s order for speech therapy, and a nurse practitioner or physician assistant may complete the EPSDT screening and sign the EPSDT referral.⁠^74,75,76

The payer’s rule is separate. Medicare pays for outpatient therapy under a plan of care certified by a physician or nonphysician practitioner, and the regulation’s 2025 text lets a signed order or referral on file, with the plan delivered within 30 days of the initial evaluation, stand in for that signature on an initial plan.⁠³⁰ Alabama Medicaid’s referral and prior-authorization rules are in the next section. A commercial plan’s rule is in its member contract and provider manual, and the clinic keeps a copy of each.

How does Alabama Medicaid pay for pediatric and adult therapy?

Alabama Medicaid is run by the Alabama Medicaid Agency, and a clinic enrolls through its provider enrollment route before it bills.⁠⁷⁷ For children, the federal EPSDT benefit requires the state to cover services that correct or ameliorate a condition found at a screening, whether or not the state plan covers them for adults.⁠⁷⁸ For children under 21, Alabama Medicaid covers physical, occupational and speech therapy through EPSDT: therapists enroll as EPSDT-only providers, the therapy must treat a condition identified during an EPSDT screening, and the provider keeps the EPSDT referral form, which is valid for the period the referring provider sets, up to 12 months.⁠^3,4,5

For adults, Alabama Medicaid covers physical therapy in a hospital outpatient setting for acute conditions (a diagnosis made within three months of the start of treatment), not chronic conditions except acute exacerbations. The agency’s list of non-covered services names speech therapy and occupational therapy for people 21 and older, and a therapist who enrolls independently bills as an EPSDT/QMB-only provider.⁠^17,18,19,20 Alabama Medicaid’s listed physical, occupational and speech therapy procedure codes generally do not require prior authorization; a service outside those codes must have it.⁠^79,80 Alabama Medicaid coordinates care through the Alabama Coordinated Health Network (ACHN), a care coordination program in seven regions. Under ACHN, a referral from a primary care physician or a network is no longer required for specialty services, except in the Lock-in and EPSDT programs, where EPSDT referrals are still required.⁠^81,82 The fee schedule is published by the agency, and a clinic reads the current file rather than a remembered rate.⁠⁸³

How does Alabama Medicaid want OT, PT and SLP claims coded?

Therapy is billed on the CMS-1500 claim form within one year of the date of service, with no copayment; therapy providers enroll as provider type 17 with specialty 170 (physical therapy), 171 (occupational therapy) or 173 (speech therapy).⁠^{84,85,86,87,88} The codes, modifiers and authorization forms are the manual’s and change with it, so the clinic reads the current therapy sections before its first claim and records the manual’s page-updated date in the payer register.

Does Alabama Medicaid pay for therapy in schools?

Local education agencies bill Alabama Medicaid for occupational therapy, physical therapy and speech-language services that are medically necessary for developing a child’s IEP or documented in it. An IEP must be completed first, and payment runs through a quarterly cost report and an annual settlement.⁠^89,90,91 A school’s billing is the district’s, under its own program; an outpatient clinic’s claim for the same child is a separate matter with its own eligibility and authorization.

Does Alabama Medicaid cover therapy by telehealth?

Alabama Medicaid lists speech therapists among the provider types it reimburses for telemedicine and lists physical and occupational therapists among those it does not. A telemedicine provider enrolls with specialty type 931, obtains the recipient’s written or verbal consent first, and has a parent or guardian attend a minor’s visit.⁠^92,93,94,95 The telehealth section below covers the state’s own rules for the session itself.

What are Alabama’s telehealth rules for therapy?

A therapist treating a patient by video needs authority to practice where the patient is located at the time of the session, and the federal telehealth site says so plainly: licensure follows the patient’s location, and a compact privilege is one route to it.⁠²¹ The speech-language pathology and audiology board’s rule holds telepractice to the same standards of practice as in-person care, requires an Alabama license unless an exemption applies, and does not allow assistants to provide telepractice.⁠^96,97

A compact privilege is not a national license: it is a privilege to practice in the specific member state that issued it, under that state’s licensing law, and a state that has enacted the compact may not yet be issuing privileges, which is why the table names the commission’s current status.⁠^22,23,24

Which business steps are specific to Alabama?

The entity is registered with the Business Entities Division of the Alabama Secretary of State, and the choice of entity is shaped by the state’s rule on who may own a therapy business.⁠³³ Alabama’s entity law defines a professional service as one that may lawfully be performed only under a license from a state licensing board, and a professional corporation may be organized to render professional services if at least one stockholder is licensed for each service, renders them only through individuals permitted to do so, and issues stock only to qualified persons.⁠^34,35,36,37 State tax registration is with the Alabama Department of Revenue’s Entity Registration unit.⁠⁹⁸ Alabama’s state sales tax is levied on the business of selling tangible personal property at retail; through September 30, 2029, sales of hearing instruments, including hearing aids, are exempt.⁠^99,100 Alabama’s workers’ compensation law does not apply to an employer that regularly employs fewer than five employees in any one business (other than building new single-family homes). An employer subject to it secures payment of compensation by insuring with an authorized insurer or by qualifying as a self-insurer.⁠^101,102 A city or county business license is a local question, answered by the city hall of the clinic’s address. The startup-costs guide carries the budget worksheet these registrations go into.

What record and privacy rules apply in Alabama?

Alabama Medicaid requires its providers to keep records that fully disclose the services furnished for three years plus the current year, and until an ongoing audit, litigation or investigation is resolved.⁠^31,32 Two federal periods sit beside it and are often confused with it: Medicare requires 7 years for documentation of orders, certifications, referrals and payment requests, and HIPAA requires 6 years for its own compliance documentation, and neither sets the retention period for the clinical chart.⁠^103,104

Alabama’s Data Breach Notification Act requires a covered entity to notify each affected individual within 45 days when sensitive personally identifying information is, or is reasonably believed to be, acquired by an unauthorized person and substantial harm is reasonably likely, and to notify the Attorney General when more than 1,000 people must be notified. An entity that follows federal breach-notification rules (and copies the Attorney General when over 1,000) is exempt.⁠^105,106,107 Alabama’s reporting law names clinics, physical therapists and any other person called upon to render aid or medical assistance to a child: each must report known or suspected child abuse or neglect orally to law enforcement or the Department of Human Resources immediately, with a written report within 72 hours.⁠¹⁰⁸

Which Alabama rules shape a pediatric clinic?

Alabama’s Early Intervention System, on the Alabama Department of Rehabilitation Services site, serves infants and toddlers under three with a developmental delay or a diagnosis that can delay development. A family or provider refers a child through the toll-free Child Find number, 1-800-543-3098, an ADRS office, or an online request at NeverTooEarlyAL.org. Alabama Medicaid’s manual gives the eligibility definition as a child from birth to three with a diagnosed condition highly likely to cause developmental delay, or a 25% delay in one or more of five developmental areas.⁠^38,39,40,41 A child who turns three moves from early intervention to the school district’s evaluation, and a private clinic’s services run beside both systems rather than inside them. Alabama’s autism coverage law requires health benefit plans issued to employers with at least 51 employees to cover screening, diagnosis and treatment of autism spectrum disorder for insureds 18 and under, including speech, occupational and physical therapy, with no visit limits. The yearly dollar caps in the law apply only to applied behavior analysis.⁠^109,110 The autism insurance mandates guide covers how such a mandate meets a plan’s own terms.

Which Alabama rules shape an adult clinic?

Medicare claims from Alabama go to Palmetto GBA, LLC, the Medicare Administrative Contractor for Jurisdiction J, Parts A and B (Alabama, Georgia and Tennessee), whose local coverage articles for therapy are the ones an Alabama clinic reads.⁠¹¹¹ Alabama Medicaid’s adult therapy rules are in the Medicaid section above.

Which associations and directory pages serve Alabama?

The state chapters are APTA Alabama for physical therapy, the Alabama Occupational Therapy Association for occupational therapy and the Speech and Hearing Association of Alabama for speech-language pathology.⁠^112,113,114 On DrSensory, families browse Alabama clinics by discipline on the occupational therapy, physical therapy and speech therapy pages for the state, which the directory builds from the clinic addresses it holds; a clinic appears on the pages of its own address.⁠¹¹⁵

Which Alabama cities have DrSensory city pages?

Beyond its three Alabama pages, the directory publishes city pages for 4 Alabama cities, 9 pages across the three disciplines, each listing the clinics whose address is in that city; a clinic appears on the city page of its address without any action of its own, and a city or discipline without a page is reached through the state page.⁠¹¹⁵

How many Alabama PT, OT and SLP clinics does DrSensory list?

DrSensory lists 60 PT, OT and SLP clinics in Alabama, on its occupational therapy, physical therapy and speech therapy pages for the state.⁠¹¹⁵

Where does each requirement come from, and what does the clinic do?

Which templates does an Alabama launch need?

How might two Alabama clinics plan a launch?

Sources

1. Alabama Board of Physical Therapy. Alabama Board of Physical Therapy. Checked October 30, 2026.
2. Alabama Legislature. Code of Alabama 1975, § 34-24-210.1, Evaluation and Treatment by Physical Therapist; Referrals. Checked October 30, 2026.
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   “(a) A physical therapist may not treat patients without a referral from a physical therapy referrer unless the physical therapist possesses a doctorate in physical therapy or a master’s degree from an accredited institution along with 10 years of clinical practice experience and is licensed as a physical therapist in this state having passed the examination of the Federation of State Boards of Physical Therapy. ... (2) A physical therapist meeting the educational requirements of subsection (a) may perform physical therapy on a patient without a referral from a physical therapy referrer. If the patient does not have a beneficial response to the physical therapy in 30 calendar days, or 11 visits, whichever occurs first, the patient shall be referred to a health care provider as appropriate.”
3. Alabama Legislative Services Agency. Ala. Admin. Code r. 560-X-11-.14, EPSDT Referred Service Providers (Alabama Medicaid Agency). Checked October 30, 2026.
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   “(1) OBRA ’89 requires that medically necessary health care, diagnosis, treatment and/or other measures described in Section 1905(a) of the Social Security Act be covered under Medicaid if identified in an EPSDT screening whether or not such services are covered in the State Plan. If services are not ordinarily provided as a Medicaid benefit for children under age 21, the providers of the service will be enrolled to provide "EPSDT only" referred care. An EPSDT referral form must be maintained by the provider for services provided as a result of a screening. ... (a) EPSDT-only providers include: physical therapists, occupational therapists, speech therapists, ... EPSDT-only services are covered by Alabama Medicaid when medically necessary and when done to correct or ameliorate a defect, physical or mental illness or other conditions identified during an EPSDT Screening Exam.”
4. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 37, Therapy (Occupational, Physical, Speech, and Applied Behavior Analysis) (October 2026). Checked October 30, 2026.
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   “This chapter regarding therapy services is specifically designed for therapy providers who meet either of the following criteria: • Provider receives a referral as a result of an EPSDT screening exam and possesses an EPSDT Referral form (Form 362) as a result of an abnormality discovered during the EPSDT exam • Provider treats QMB recipients ...”
5. Alabama Legislative Services Agency. Ala. Admin. Code r. 560-X-11-.14, EPSDT Referred Service Providers (Alabama Medicaid Agency). “(EPSDT screening referral forms are valid only for the time specified by the referring provider or up to a maximum of twelve (12) months).” Checked October 30, 2026.
6. Alabama State Board of Occupational Therapy. Alabama State Board of Occupational Therapy. Checked October 30, 2026.
7. Alabama Board of Examiners for Speech-Language Pathology and Audiology. Alabama Board of Examiners for Speech-Language Pathology and Audiology (ABESPA). Checked October 30, 2026.
8. Alabama Legislature. Code of Alabama 1975, § 34-24-191, Definitions (physical therapy). Checked October 30, 2026.
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   “(12) PHYSICAL THERAPY REFERRER. A physician licensed to practice medicine or surgery, a dentist licensed to practice dentistry, a licensed chiropractor, a licensed assistant to a physician acting pursuant to a valid supervisory agreement, or a licensed certified registered nurse practitioner in a collaborative practice agreement with a licensed physician.”
9. Alabama Legislature. Code of Alabama 1975, § 34-24-210.1, Evaluation and Treatment by Physical Therapist; Referrals. Checked October 30, 2026.
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   “... a physical therapist meeting the educational requirements of subsection (a) without a referral may perform an initial screening evaluation or consultation for patients with non-work related injuries, infirmities, diseases, or conditions to determine the need for physical therapy, establish a plan of care, and initiate physical therapy services without a referral. An individual seeking treatment for physical therapy services who is paying cash shall have direct access without restriction.”
10. Alabama Legislature. Code of Alabama 1975, § 34-24-210.1, Evaluation and Treatment by Physical Therapist; Referrals. Checked October 30, 2026.
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    “These treatment limitations shall not apply to any of the following: a. A child with a diagnosed developmental disability pursuant to the plan of care for the child developed by a physical therapy referrer. b. A patient of a home health agency pursuant to the agency’s plan of care for the patient. c. A patient of a nursing home pursuant to the plan of care for the patient developed by the medical staff of the nursing home. d. A patient previously diagnosed with a chronic condition for which physical therapy services are appropriate after informing the physical therapy referrer rendering the diagnosis. The diagnosis shall have been made within the immediately preceding 120 days. The physical therapist shall provide the physical therapy referrer with a plan of care for physical therapy services within the first 15 days of treatment. e. Education or activities in a wellness setting relating to conditioning for the purpose of prevention of injury, reduction of stress, or promotion of fitness.”
11. Alabama Legislature. Code of Alabama 1975, § 34-24-210.1, Evaluation and Treatment by Physical Therapist; Referrals. Checked October 30, 2026.
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    “(f) A physical therapist treating a patient referenced in subdivision (d)(2) without a referral from a physical therapy referrer, prior to beginning treatment, shall provide written disclosure to the patient that the physical therapist’s assessment is not a medical diagnosis and is not based on any radiologic or medical imaging.”
12. Alabama Legislature. Code of Alabama 1975, § 34-24-210.1, Evaluation and Treatment by Physical Therapist; Referrals. Checked October 30, 2026.
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    “(7) Performing physical therapy on any individual who suffered a concussion within the previous 45 days, unless cleared for physical therapy by a physician licensed to practice medicine or osteopathy. ... (9) Performing physical therapy on any individual who has undergone a surgical procedure for a diagnosed condition within the previous 90 days without a referral from a physical therapy referrer ...”
13. Alabama Legislature. Code of Alabama 1975, § 34-24-210.1, Evaluation and Treatment by Physical Therapist; Referrals. Checked October 30, 2026.
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    “(j) For any physical therapist treating a patient without a referral from a physical therapy referrer, the physical therapist shall maintain professional liability insurance at a limit of no less than one hundred thousand dollars ($100,000) per occurrence and three hundred thousand dollars ($300,000) in aggregate.”
14. Alabama Legislature. Code of Alabama 1975, § 34-24-210.1, Evaluation and Treatment by Physical Therapist; Referrals. Checked October 30, 2026.
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    “(e) The physical therapist shall immediately refer a patient to other health care providers upon a measurable deterioration in the patient’s condition. ... (g) Failure of a physical therapist to timely refer the patient to a physical therapy referrer when the patient exhibits or develops signs, symptoms, or conditions requiring treatment beyond the scope of practice of physical therapy shall constitute unprofessional conduct under the rules of the board.”
15. Alabama Legislature. Code of Alabama 1975, § 34-24-210.1, Evaluation and Treatment by Physical Therapist; Referrals. Checked October 30, 2026.
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    “(m) Nothing contained in this section shall be construed to create a requirement that any health benefit plan, group insurance plan, policy, or contract for health care services that covers hospital, medical, or surgical expenses, health maintenance organizations, preferred provider organizations, medical service organizations, physician-hospital organizations, or any person, firm, corporation, joint venture, or other similar business entity that pays for, purchases, or furnishes group health care services to patients, insureds, or beneficiaries in this state, including entities created pursuant to Article 6 of Chapter 20, Title 10A, commencing with Section 10A-20-6.01, provide coverage or reimbursement for the services described or authorized in this section.”
16. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 37, Therapy (Occupational, Physical, Speech, and Applied Behavior Analysis) (October 2026). “Physical Therapy is not covered when provided in a physician’s office. ... Physical therapy is covered only when prescribed by a physician.” Checked October 30, 2026.
17. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 19, Hospital (October 2026). Checked October 30, 2026.
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    “Physical therapy is a covered service based on medical necessity. Physical therapy is covered in a hospital outpatient setting for acute conditions. Recipients receiving therapy must be under the care of a physician or non-physician practitioner who certifies the recipient’s need for therapy. ... • Physical therapy is covered for acute conditions only. An acute condition is a new diagnosis that was made within three months of the beginning date of the physical therapy treatments. ... • Chronic conditions are not covered except for acute exacerbations or as a result of an EPSDT screening.”
18. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 19, Hospital (October 2026). “... there must be documentation in the patient’s medical record that a physician or non-physician practitioner has recertified the patient within 60 days after the therapy began and every 30 days past the 60th day.” Checked October 30, 2026.
19. Alabama Medicaid Agency. Medicaid Non-Covered Services (5/2023). “Below is a partial listing of some goods and services that are not covered by Medicaid in Alabama. ... Medicaid will NOT pay for: ... • Respiratory therapy, speech therapy, and occupational therapy (age 21 and older).” Checked October 30, 2026.
20. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 37, Therapy (Occupational, Physical, Speech, and Applied Behavior Analysis) (October 2026). Checked October 30, 2026.
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    “Physical therapy is covered for acute conditions in a hospital outpatient setting for non-EPSDT recipients. For more information regarding this, refer to Chapter 19, Hospital. ... Therapists may enroll independently and have their own NPI bill on a CMS-1500 claim form as an EPSDT/QMB-only provider.”
21. U.S. Department of Health and Human Services. Getting started with licensure (Telehealth.HHS.gov, last updated February 21, 2024). Checked October 26, 2026.
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    “Health professionals must meet the licensure requirements of the state where they are located and be licensed or legally permitted to practice in the state where the patient is located”. Its companion page, Licensing across state lines (last updated April 30, 2025): “The ability to deliver health care services across state lines varies based on state regulations”; “Prior to an appointment, providers should verify patient location and obtain consent”; “Compacts allow participating health care providers to practice in participating states”.
22. PT Compact Commission. PT Compact Map. “Member States (38) Alabama Alaska ... 38 Member States Actively Issuing and Accepting Compact Privileges ...” Checked October 30, 2026.
23. Alabama Board of Physical Therapy. PT Compact. “The Alabama Board of Physical Therapy is now an active member state in the Physical Therapy Compact. ... Alabama requires that you pass our Jurisprudence exam prior to purchasing your privilege to practice in Alabama.” Checked October 30, 2026.
24. Alabama Legislature. Code of Alabama 1975, § 34-24-220, Purpose (Physical Therapy Licensure Compact). “(a) This article shall be known and may be cited as the Physical Therapy Licensure Compact.” Checked October 30, 2026.
25. Occupational Therapy Compact Commission. Before You Apply for an OT Compact Privilege. “States not listed below are not a member of the Occupational Therapy Compact. ... State Accepting OTC Applications? ... Alabama Not Yet ...” Checked October 30, 2026.
26. Alabama Legislature. Code of Alabama 1975, § 34-39-30, Purpose (Occupational Therapy Licensure Compact). “(a) The purpose of this compact is to facilitate interstate practice of occupational therapy with the goal of improving public access to occupational therapy services. ... (Act 2022-93, §1.)” Checked October 30, 2026.
27. Audiology and Speech-Language Pathology Interstate Compact Commission. Delegate Information. “Member State Appointed Delegates ... Alabama Audiology ... Alabama SLP ...” Checked October 30, 2026.
28. Audiology and Speech-Language Pathology Interstate Compact Commission. ASLP-IC Home. “Registration for compact privileges to practice is open for licensed practitioners in Louisiana, Ohio, Tennessee, and West Virginia.” Checked October 30, 2026.
29. Alabama Legislature. Code of Alabama 1975, § 34-28A-60, Purpose (Audiology and Speech-Language Pathology Interstate Compact). “This article shall be known and may be cited as the Audiology and Speech-Language Pathology Interstate Compact.” Checked October 30, 2026.
30. Code of Federal Regulations. 42 CFR 424.24, Requirements for medical and other health services furnished by providers under Medicare Part B (eCFR, up to date as of October 22, 2026; paragraph (c), outpatient physical therapy, occupational therapy and speech-language pathology services). Checked October 26, 2026.
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    “The individual needs, or needed, physical therapy, occupational therapy, or speech-language pathology services.”; “The services were furnished while the individual was under the care of a physician, nurse practitioner, clinical nurse specialist, or physician assistant.”; “The initial certification must be obtained as soon as possible after the plan is established.”; “Recertification is required at least every 90 days.”; “When it is recertified, the plan or other documentation in the patient’s record must indicate the continuing need for physical therapy, occupational therapy or speech-language pathology services.”; “the therapist has documented evidence that the plan of treatment has been delivered to the physician, NP, PA, or CNS within 30 days of completion of the initial evaluation, the certification does not need to be signed by a physician, NP, CNS, or PA who has knowledge of the case.”; “No references to an order or referral in this subsection shall be construed to require an order or referral for outpatient physical therapy, occupational therapy, or speech-language pathology services.”.
31. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 7, Understanding Your Rights and Responsibilities as a Provider (October 2026). Checked October 30, 2026.
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    “Alabama Medicaid providers will keep detailed records in Alabama, of such quality, sufficiency, and completeness except as provided in subparagraph (5) Rule No. 560-X-16-.02, that will fully disclose the extent and cost of services, equipment, or supplies furnished eligible recipients. These records will be retained for a period of three (3) years plus the current year.”
32. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 7, Understanding Your Rights and Responsibilities as a Provider (October 2026). “In the event of ongoing audits, litigation, or investigation, records must be retained until resolution of the ongoing action.” Checked October 30, 2026.
33. Alabama Secretary of State. Business Entities. “The Business Entity Division operates as a depository for records of domestic entities and foreign entities that have qualified to transact business in Alabama. The types of entities we serve include For-Profit Corporations, Non-Profit Corporations, Limited Liability Companies, Limited Partnerships, Registered Limited Liability Partnerships, and Limited Liability Limited Partnerships.” Checked October 30, 2026.
34. Alabama Legislature. Code of Alabama 1975, § 10A-1-1.03, Definitions (Alabama Business and Nonprofit Entities Code). “(81) PROFESSIONAL SERVICE. Any type of service that may lawfully be performed only pursuant to a license issued by a state court, state regulatory licensing board, or other like agency pursuant to state laws.” Checked October 30, 2026.
35. Alabama Legislature. Code of Alabama 1975, § 10A-4-2.01, Purposes for Which Professional Corporations May Be Organized. Checked October 30, 2026.
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    “A domestic professional corporation may be organized under this chapter for the purpose of, and shall have the power to render, professional services if the domestic professional corporation complies with the rules of the licensing authority for such profession; provided that in the case of a professional corporation, at least one stockholder of the professional corporation is duly licensed to provide each professional service for which the professional corporation is organized ...”
36. Alabama Legislature. Code of Alabama 1975, § 10A-4-2.04, Rendition of Professional Services. “A professional corporation, domestic or foreign, may render professional services in this state only through individuals permitted to render the services in this state ...” Checked October 30, 2026.
37. Alabama Legislature. Code of Alabama 1975, § 10A-4-3.01, Issuance and Transfer of Stock. “(a) A domestic professional corporation may issue stock, fractions of a share of stock, and rights or options to purchase stock only to qualified persons.” Checked October 30, 2026.
38. Alabama Department of Rehabilitation Services. Alabama’s Early Intervention System (EI). “Early Intervention provides supports and services for infants and toddlers under the age of three who have a developmental delay or a medical diagnosis that can delay normal development, which can prevent the child from meeting developmental milestones.” Checked October 30, 2026.
39. Alabama Department of Rehabilitation Services. Alabama’s Early Intervention System (EI). “How do I get EI services for my child or a child in my care? Call our toll-free Child Find number: 1-800-543-3098 Contact an ADRS office near you. Visit NeverTooEarlyAL.org to request a referral online.” Checked October 30, 2026.
40. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 108, Early Intervention Services (October 2026). Checked October 30, 2026.
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    “Alabama’s eligibility definition for Early Intervention is: a child birth to three years of age with a diagnosed mental or physical condition which has a high probability of resulting in developmental delay or who is experiencing a 25% delay in one or more of the five developmental areas: cognitive, physical to include vision/hearing, communication, social/emotional and adaptive.”
41. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 108, Early Intervention Services (October 2026). “Eligible infants/toddlers receive EI Services through providers who contract with Medicaid to provide services to the eligible population.” Checked October 30, 2026.
42. Alabama Legislature. Code of Alabama 1975, § 34-24-192, Board of Physical Therapy - Generally. “(a) Composition; appointment and terms of members. The Board of Physical Therapy shall consist of seven members. Four members shall be physical therapists, two members shall be physical therapist assistants, and one member shall be a consumer.” Checked October 30, 2026.
43. Alabama Legislature. Code of Alabama 1975, § 34-24-216, Renewal of License; Continuing Education. Checked October 30, 2026.
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    “(a) All licenses issued by the board to physical therapists and physical therapist assistants shall expire on the first day of October of the year next succeeding the issuance thereof. A license may be renewed on the payment, on or before November first of each year, to the board of a fee set by the board.”
44. Alabama Legislative Services Agency. Ala. Admin. Code r. 700-X-2-.10, Renewal Of License (Alabama Board of Physical Therapy). “(1) Annual Renewal Required. Each license expires on October 1 of the year following its issuance.” Checked October 30, 2026.
45. Alabama Board of Physical Therapy. License Renewal. “Renewals are annual. Each license expires on October 1 of the year following its issuance. ... Annual renewal period is July 1 through September 30 at midnight.” Checked October 30, 2026.
46. Alabama Legislative Services Agency. Ala. Admin. Code r. 700-X-2-.10, Renewal Of License (Alabama Board of Physical Therapy). Checked October 30, 2026.
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    “1. Each physical therapist and physical therapist assistant licensed to practice by this Board shall complete for each compliance period, a minimum of ten (10) hours of continuing education activities. One hour of continuing education is defined as 50 minutes of engagement in the continuing education activity. Activities of 15, 30, or 45 minutes may be submitted for 0.25, 0.50, or 0.75 hours of credit, respectively, provided all other continuing education requirements outlined in these guidelines are met. October 1 through September 30 of the next year shall constitute a compliance period.”
47. Alabama Legislative Services Agency. Ala. Admin. Code r. 700-X-2-.10, Renewal Of License (Alabama Board of Physical Therapy). Checked October 30, 2026.
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    “4. Beginning with the compliance period starting October 1, 2015, licensees complete at least two (2) hours of continuing education every fifth year on the topic of Alabama physical therapy jurisprudence, covering both the Practice Act and the Administrative Code. Both PTs and PTAs will be required to fulfill this requirement when renewing their license in years ending in zero (0) or five (5) (i.e., 2020, 2025, 2030, etc.).”
48. Alabama Legislature. Code of Alabama 1975, § 34-24-210.1, Evaluation and Treatment by Physical Therapist; Referrals. “(b) In addition to the requirements of Section 34-24-216, a physical therapist shall annually complete an additional two hours of continuing education focusing on the professional standard of care.” Checked October 30, 2026.
49. Alabama Board of Physical Therapy. Continuing Education. “Ten (10) hours of continuing education are required with each renewal application. ... Twelve (12) hours of continuing education are required for qualified PTs seeking to provide Direct Access.” Checked October 30, 2026.
50. Alabama Legislature. Code of Alabama 1975, § 34-24-191, Definitions (physical therapy). Checked October 30, 2026.
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    “(8) PHYSICAL THERAPIST ASSISTANT. A person who assists in the practice of physical therapy and whose activities require an understanding of physical therapy but do not require professional or advanced training in the anatomical, biological, and physical sciences involved in the practice of physical therapy. The physical therapist assistant shall practice only under the direction of a licensed physical therapist.”
51. Alabama Legislative Services Agency. Ala. Admin. Code r. 700-X-3-.03, Roles And Responsibilities Of Licensees (Alabama Board of Physical Therapy). Checked October 30, 2026.
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    “(a) Direction means the action of the physical therapist in delegating duties to a physical therapist assistant, maintaining close communication with the physical therapist assistant, and overseeing the physical therapist assistant’s activities on a frequent regularly scheduled basis. ... 1. To practice only under the direction of a physical therapist licensed to practice in the State of Alabama. ... 3. To perform treatment procedures as delegated by the physical therapist but not to initiate or alter a treatment plan.”
52. Alabama Legislature. Code of Alabama 1975, § 34-24-210.1, Evaluation and Treatment by Physical Therapist; Referrals. “(h) A physical therapist is prohibited from doing any of the following: ... (10) Directing or supervising more than four physical therapy assistants at one time.” Checked October 30, 2026.
53. Alabama Legislature. Code of Alabama 1975, § 34-39-6, Board of Occupational Therapy Established; Composition; Fund Created. Checked October 30, 2026.
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    “(a) There is established the Alabama State Board of Occupational Therapy. (1) The board shall consist of five members, four of whom shall be involved in the practice of occupational therapy, of which one shall be an occupational therapy assistant.”
54. Alabama Legislative Services Agency. Ala. Admin. Code r. 625-X-5-.01, General Provisions (Alabama State Board of Occupational Therapy). “In order to continue the practice of occupational therapy as an Occupational Therapist or an Occupational Therapy Assistant, each license as issued by the Board must be annually/biennially renewed by the Board.” Checked October 30, 2026.
55. Alabama Legislature. Code of Alabama 1975, § 34-39-13, Expiration and Renewal of Licenses; Fee; Continuing Education; Late Fee. Checked October 30, 2026.
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    “(a) All licenses under this chapter shall be subject to renewal and shall expire unless renewed in the manner prescribed by the rules and regulations of the board upon the payment of a renewal fee. The board may set a required number of continuing education units for license renewal.”
56. Alabama State Board of Occupational Therapy. Renewal Instructions for Licenses Expiring on October 31, 2026. “RENEWAL INSTRUCTIONS for LICENSES EXPIRING on October 31, 2026 ... *ALL required documentation must be received, postmarked, or transmitted by MIDNIGHT on AUGUST 31, 2026 (60 days prior to your expiration date).” Checked October 30, 2026.
57. Alabama Legislative Services Agency. Ala. Admin. Code r. 625-X-5-.02, Requisites For Renewal (Alabama State Board of Occupational Therapy). “To qualify for a renewal of licenses previously issued by the Board, the license holder shall, 60 days prior to the expiration for the license, comply with all of the following requirements ...” Checked October 30, 2026.
58. Alabama Legislative Services Agency. Ala. Admin. Code r. 625-X-5-.02, Requisites For Renewal (Alabama State Board of Occupational Therapy). Checked October 30, 2026.
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    “(1) An Occupational Therapist must obtain 1.5 CEUs (or 15 contact hours) annually or 3.0 CEUs (or 30 contact hours) biennially. No more than 1/3 of continuing education credits may be administration/management/academic related with the remainder related to direct patient treatment. No more that a 1/3 hours can be generated by the therapist’s professional presentations.”
59. Alabama Legislative Services Agency. Ala. Admin. Code r. 625-X-5-.02, Requisites For Renewal (Alabama State Board of Occupational Therapy). “(2) An Occupational Therapy Assistant must obtain 1.0 CEU (or 10 contact hours) annually or 2.0 CEUs (or 20 contact hours) biennially.” Checked October 30, 2026.
60. Alabama Legislative Services Agency. Ala. Admin. Code r. 625-X-8-.01, Supervision Of Licensed Occupational Therapy Assistants. Checked October 30, 2026.
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    “(3) An occupational therapist may assign an increased level of supervision if necessary for the safety of a patient or client. The levels of supervision are: (a) Direct Supervision: the supervising occupational therapist is in the immediate area of the occupational therapy assistant while performing supportive services. (b) Close Supervision: the supervising occupational therapist provides initial direction to the occupational therapy assistant and daily contact while on the premises. (c) General Supervision: the supervising occupational therapist has face-to-face contact with the occupational therapy assistant at least once every 30-calendar days, with the supervising occupational therapist available by telephone, electronic, or written communication. ... (a) An occupational therapist may supervise up to three (3) full-time occupational therapy assistants, but never more than two (2) occupational therapy assistants who require “direct” level of supervision. ... (6) A licensed occupational therapy assistant shall not: (a) Evaluate or develop a treatment plan independently ...”
61. Alabama Legislature. Code of Alabama 1975, § 34-28A-40, Creation; Composition (Board of Examiners for Speech-Language Pathology and Audiology). “(a) There is established as an independent agency of the executive branch of the government of the State of Alabama, the Alabama Board of Examiners for Speech-Language Pathology and Audiology.” Checked October 30, 2026.
62. Alabama Legislature. Code of Alabama 1975, § 34-28A-20, Required; Licenses to Be Granted to Qualified Applicants. “(b) Licensure shall be granted either in speech-language pathology or audiology if the applicant meets the respective qualifications.” Checked October 30, 2026.
63. Alabama Legislature. Code of Alabama 1975, § 34-28A-3, Persons and Practices Exempt from Chapter. Checked October 30, 2026.
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    “Nothing in this chapter shall be construed as preventing or restricting any of the following: ... (4) The activities and services of a person who holds a valid and current credential as a speech or hearing specialist, or both, issued by the Department of Education of this state or a person who is employed as a speech-language pathologist or audiologist by the government of the United States, if the person performs speech-language pathology and audiology services solely within the confines or under the jurisdiction of the organization by which he or she is employed.”
64. Alabama Legislature. Code of Alabama 1975, § 34-28A-25, Issuance and Renewal of Licenses; Continuing Education; Inactive Status. Checked October 30, 2026.
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    “(c) Licenses shall expire on December 31 following their issuance or renewal and are invalid thereafter unless renewed. The board shall notify every person licensed under this chapter of the date of expiration and the amount of the renewal fee. This notice shall be mailed to his or her last known address at least one month before the expiration of the license. Every person licensed under this chapter shall, on or before January 1 of each year, pay a fee for renewal of license to the board.”
65. Alabama Legislative Services Agency. Ala. Admin. Code r. 870-X-4-.02, Renewal (Board of Examiners for Speech-Language Pathology and Audiology). Checked October 30, 2026.
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    “(1) Licenses must be renewed annually and the license renewal fee of $100.00 must be paid to the Board on or before January 1 following their issuance or renewal. The license renewal application must include indication that the licensee has met continuing education requirements as specified in 870-X-4-.08.”
66. Alabama Legislative Services Agency. Ala. Admin. Code r. 870-X-4-.08, Mandatory Continuing Education. Checked October 30, 2026.
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    “(b) Each licensee shall annually complete and report at least twelve (12) hours of continuing education. A minimum of ten (10) shall be in the area of licensure – Content Area I; one of the ten hours should be in the area of ethics; and a maximum of (2) may be in areas related to the profession of speech-language pathology or audiology – Content Area II, all which must contribute to professional competency of licensee.”
67. Alabama Board of Examiners for Speech-Language Pathology and Audiology. Continuing Education. “12 CE hours (CEH) are required each year* ...” Checked October 30, 2026.
68. Alabama Legislature. Code of Alabama 1975, § 34-28A-21.1, Qualifications for Licensure as Speech-Language Pathology Assistant. Checked October 30, 2026.
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    “(1) Practice only under the supervision of a licensed speech-language pathologist. ... (2) The supervising speech-language pathologist shall have held a full, unrestricted speech-language pathologist license for at least two years before supervising the speech-language pathology assistant and shall possess the necessary credentials required by the board. A supervising speech-language pathologist may not supervise more than three full-time equivalent speech-language pathology assistants in any one setting. ... (d) Licensure as a speech-language pathology assistant may be renewed annually, pursuant to this chapter, without limitation as to number of times renewed. (e) The board shall adopt rules as necessary to implement this section. (Act 2025-382, §1.)”
69. Alabama Legislative Services Agency. Ala. Admin. Code r. 870-X-2-.06, Assistant Registration (as amended effective August 14, 2026). Checked October 30, 2026.
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    “The assistant must be under the direct supervision of a licensee. Supervision requires the physical presence of the licensee in the same facility one hundred percent (100%) of the time when the assistant is carrying out assigned clinical responsibilities. The licensed supervisor must document direct observation of at least ten percent (10%) of all clinical services provided by the assistant.”
70. Alabama Legislature. Code of Alabama 1975, § 34-39-3, Definitions (Occupational Therapy Practice Act). Checked October 30, 2026.
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    “Notwithstanding any other provision of this chapter, no occupational therapy treatment programs to be rendered by an occupational therapist, occupational therapy assistant, or occupational therapy aide shall be initiated without the referral of a licensed physician, a licensed chiropractor, a licensed optometrist, a licensed assistant to a physician acting pursuant to a valid supervisory agreement, a licensed certified registered nurse practitioner in a collaborative practice agreement with a licensed physician, a licensed psychologist, or a licensed dentist who shall establish a diagnosis of the condition for which the individual will receive occupational therapy services.”
71. Alabama Legislature. Code of Alabama 1975, § 34-39-3, Definitions (Occupational Therapy Practice Act). Checked October 30, 2026.
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    “In cases of long-term or chronic disease, disability, or dysfunction, or any combination of the foregoing, requiring continued occupational therapy services, the person receiving occupational therapy services shall be reevaluated by a licensed physician, a licensed chiropractor, a licensed optometrist, a licensed assistant to a physician acting pursuant to a valid supervisory agreement, a licensed certified registered nurse practitioner in a collaborative practice agreement with a licensed physician, a licensed psychologist, or a licensed dentist at least annually for confirmation or modification of the diagnosis.”
72. Alabama Legislature. Code of Alabama 1975, § 34-39-3, Definitions (Occupational Therapy Practice Act). Checked October 30, 2026.
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    “Occupational therapists performing services that are not related to injury, disease, or illness that are performed in a wellness or community setting for the purposes of enhancing performance in everyday activities are exempt from this referral requirement. Occupational therapists employed by state agencies and those employed by the public schools and colleges of this state who provide screening and rehabilitation services for the educationally related needs of the students are exempt from this referral requirement.”
73. Alabama Legislative Services Agency. Ala. Admin. Code r. 560-X-11-.14, EPSDT Referred Service Providers (Alabama Medicaid Agency). Checked October 30, 2026.
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    “(b) Occupational Therapists (OT) - A qualified OT must be licensed by the Alabama State Board of Occupational Therapy. Services provided must be ordered by a physician for an identified condition(s) noted during the EPSDT screening exam and provided by or under the direct supervision of a qualified occupational therapist.”
74. Alabama Legislature. Code of Alabama 1975, § 34-28A-20, Required; Licenses to Be Granted to Qualified Applicants. “(a) Under no circumstances shall any person practice or represent himself or herself as a speech-language pathologist or audiologist in this state unless he or she is licensed in accordance with this chapter.” Checked October 30, 2026.
75. Alabama Legislature. Code of Alabama 1975, § 34-28A-1, Definitions (speech-language pathology and audiology). Checked October 30, 2026.
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    “(7) SPEECH PATHOLOGY or SPEECH-LANGUAGE PATHOLOGY. The application of principles, methods, and procedures for the measurement, testing, evaluation, prediction, counseling, instruction, habilitation, or rehabilitation related to the development and disorders of speech, voice, or language for the purpose of evaluating, preventing, ameliorating, or modifying such disorders and conditions in individuals or groups of individuals, or both.”
76. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 37, Therapy (Occupational, Physical, Speech, and Applied Behavior Analysis) (October 2026). Checked October 30, 2026.
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    “Speech therapy services must be ordered by a physician and must be provided by or under the direct supervision of a qualified speech therapist. A non-physician practitioner such as a nurse practitioner or a physician assistant can complete an EPSDT screening, order a speech therapy consult then sign an EPSDT referral to see a specialist.”
77. Alabama Medicaid Agency. Provider Enrollment and Forms. Checked October 30, 2026.
78. Medicaid.gov (Centers for Medicare & Medicaid Services). Early and Periodic Screening, Diagnostic, and Treatment (Medicaid benefit page). Checked October 26, 2026.
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    “The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid.”; “It is the responsibility of states to determine medical necessity on a case-by-case basis.”.
79. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 37, Therapy (Occupational, Physical, Speech, and Applied Behavior Analysis) (October 2026). “Physical, Occupations, and Speech service procedure codes generally do not require prior authorization. Any service that is warranted outside of these codes must have prior authorization.” Checked October 30, 2026.
80. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 37, Therapy (Occupational, Physical, Speech, and Applied Behavior Analysis) (October 2026). “To determine if a procedure code requires prior authorization, use the Automated Voice Response System (AVRS).” Checked October 30, 2026.
81. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 40, Alabama Coordinated Health Network (ACHN) Primary Care Physician (PCP) and ACHN Entities Billing (October 2026). Checked October 30, 2026.
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    “The ACHN Program will effectively link recipients, providers, and community resources in each of seven (7) newly defined regions to improve health outcomes for Medicaid recipients. Care Coordination within the ACHN is a single program that will allow the Agency and Providers a more effective platform for service delivery and improved quality.”
82. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 40, Alabama Coordinated Health Network (ACHN) Primary Care Physician (PCP) and ACHN Entities Billing (October 2026). Checked October 30, 2026.
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    “PCP to PCP referrals are not required. Under the ACHN program for specialty services, a referral from a PCP or an ACHN Network is no longer required (with the exception of Lock-in and EPSDT programs). EPSDT referrals will continue to be required.”
83. Alabama Medicaid Agency. Fee Schedules. Checked October 30, 2026.
84. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 37, Therapy (Occupational, Physical, Speech, and Applied Behavior Analysis) (October 2026). Checked October 30, 2026.
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    “Therapy services are billed using the CMS-1500 claim form. ... Medicaid requires all claims for therapy services to be filed within one year of the date of service. ... Copayment does not apply to therapy services.”
85. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 37, Therapy (Occupational, Physical, Speech, and Applied Behavior Analysis) (October 2026). “Therapy providers are assigned a provider type of 17 (Therapy). Valid specialties for therapy providers include the following: • Occupational Therapy (171) • Physical Therapy (170) • Speech Therapy (173)” Checked October 30, 2026.
86. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 37, Therapy (Occupational, Physical, Speech, and Applied Behavior Analysis) (October 2026). Checked October 30, 2026.
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    “These procedure codes cannot be span billed and must be submitted for each date of service provided. ... The Physical Therapist must render the hands-on treatment, write and sign the treatment note at a minimum of every sixth visit.”
87. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 37, Therapy (Occupational, Physical, Speech, and Applied Behavior Analysis) (October 2026). “Use revenue code 43x when billing claims for occupational therapy. ... Medicaid does not cover group occupational therapy.” Checked October 30, 2026.
88. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 37, Therapy (Occupational, Physical, Speech, and Applied Behavior Analysis) (October 2026). “In order to be a covered benefit, speech therapy must be ordered by a physician and perform in an office location.” Checked October 30, 2026.
89. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 103, Local Education Agencies (LEAs) (October 2026). Checked October 30, 2026.
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    “Covered services are listed in the Alabama State Plan of Medical Assistance and are medically necessary for the development of the IEP or fully documented in the IEP. An IEP must be completed in order for services to be billed. Covered services are: ... • Occupational Therapy ... • Physical Therapy ... • Speech/Language Services ...”
90. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 103, Local Education Agencies (LEAs) (October 2026). “Reimbursement rates through the MMIS system have been set to zero to enable payments to be processed through the quarterly Cost Report and annual settlement process.” Checked October 30, 2026.
91. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 103, Local Education Agencies (LEAs) (October 2026). “Regulations implementing the Individuals with Disabilities Education Act of 2004 require that school districts secure parental permission prior to billing Medicaid for services provided by the school districts.” Checked October 30, 2026.
92. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 112, Telemedicine Services (October 2026). “Provider Types Eligible for Reimbursement for Telemedicine Services ... • Speech Therapists ... Provider Types Not Eligible for Reimbursement for Telemedicine Services • Physical Therapists • Occupational Therapists ...” Checked October 30, 2026.
93. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 112, Telemedicine Services (October 2026). Checked October 30, 2026.
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    “Providers must submit the Telemedicine Service Agreement/Certification to Medicaid’s fiscal agent. The form is located on the Medicaid website at: www.medicaid.alabama.gov. Once the form is received, providers will be enrolled with Medicaid with a specialty type of 931 (Telemedicine Service). Providers must have the specialty type of 931 to bill for telemedicine services.”
94. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 112, Telemedicine Services (October 2026). “Providers must obtain prior written or verbal consent from the recipient before services are rendered. ... Telemedicine services provided to minors under the age of medical consent must have a parent or legal guardian attend the telemedicine visit.” Checked October 30, 2026.
95. Alabama Medicaid Agency. Alabama Medicaid Provider Billing Manual, Chapter 37, Therapy (Occupational, Physical, Speech, and Applied Behavior Analysis) (October 2026). “Providers must place the “FQ” modifier on the claim to designate that the service was rendered via audio only telecommunication method.” Checked October 30, 2026.
96. Alabama Legislative Services Agency. Ala. Admin. Code r. 870-X-7-.05, Regulation of Telepractice. Checked October 30, 2026.
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    “(1) Telepractice is subject to the same standards of practice stated in 870-X-7-.01 through .04, as if the person being treated were physically present with the licensee. ... (3) Providers must hold a license in the State of Alabama unless there is a qualifying exemption as noted in Code of Ala. 1975, Section 34-28A-3; 870-X-2-.01 and shall be in compliance with the statutory and regulatory requirements of the patient site. ... (4) Telepractice services may not be administered by assistants.”
97. Alabama Legislative Services Agency. Ala. Admin. Code r. 870-X-7-.05, Regulation of Telepractice. “(8) Notification of telepractice services shall be provided to the patient and guardian if the patient is a minor. The notification shall include the right to refuse telepractice services and options for alternate service delivery.” Checked October 30, 2026.
98. Alabama Department of Revenue. Entity Registration - Alabama Department of Revenue. Checked October 30, 2026.
99. Alabama Legislature. Code of Alabama 1975, § 40-23-2, Tax Levied on Gross Receipts; Certain Sales Exempt; Disposition of Funds. “... engaged or continuing within this state, in the business of selling at retail any tangible personal property whatsoever, including merchandise and commodities of every kind and character ...” Checked October 30, 2026.
100. Alabama Legislature. Code of Alabama 1975, § 40-23-4, Exemptions (sales tax). Checked October 30, 2026.
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     “(a) There are exempted from the provisions of this division and from the computation of the amount of the tax levied, assessed, or payable under this division the following: ... (55) For the period commencing on October 1, 2024, and ending September 30, 2029, unless extended by an act of the Legislature, the gross proceeds of the sale or sales of hearing instruments as defined in Section 34-14-1, including hearing aids.”
101. Alabama Legislature. Code of Alabama 1975, § 25-5-50, Applicability; Exemptions (workers’ compensation). Checked October 30, 2026.
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     “(a) This article and Article 2 of this chapter shall not be construed or held to apply to ... an employer who regularly employs less than five employees in any one business, other than the business of constructing or assisting on-site in the construction of new single-family, detached residential dwellings ...”
102. Alabama Legislature. Code of Alabama 1975, § 25-5-8, Employers’ Options to Secure Payment of Compensation. “(a) Option to insure risks. An employer subject to this chapter may secure the payment of compensation under this chapter by insuring and keeping insured his or her liability ...” Checked October 30, 2026.
103. Code of Federal Regulations. 42 CFR 424.516, Additional provider and supplier requirements for enrolling and maintaining active enrollment status in the Medicare program (eCFR, up to date as of October 22, 2026; paragraph (f), Maintaining and providing access to documentation). Checked October 26, 2026.
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     “A provider or a supplier that furnishes covered ordered, certified, referred, or prescribed Part A or B services, items or drugs is required to—”; “Maintain documentation (as described in paragraph (f)(1)(ii) of this section) for 7 years from the date of service; and”; “Upon the request of CMS or a Medicare contractor, to provide access to that documentation”; “The documentation includes written and electronic documents (including the NPI of the physician or, when permitted, other eligible professional who ordered, certified, referred, or prescribed the Part A or B service, item, or drug) relating to written orders, certifications, referrals, prescriptions, and requests for payments for Part A or B services, items or drugs.”.
104. Code of Federal Regulations. 45 CFR 164.316, Policies and procedures and documentation requirements (eCFR, up to date as of October 22, 2026; HIPAA Security Rule; paragraph (b)). Checked October 26, 2026.
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     “Maintain the policies and procedures implemented to comply with this subpart in written (which may be electronic) form; and”; “If an action, activity or assessment is required by this subpart to be documented, maintain a written (which may be electronic) record of the action, activity, or assessment.”; “Retain the documentation required by paragraph (b)(1) of this section for 6 years from the date of its creation or the date when it last was in effect, whichever is later.”.
105. Alabama Legislature. Code of Alabama 1975, § 8-38-5, Notice of Security Breach - Individuals Affected. Checked October 30, 2026.
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     “(a) A covered entity that is not a third-party agent that determines under Section 8-38-4 that, as a result of a breach of security, sensitive personally identifying information has been acquired or is reasonably believed to have been acquired by an unauthorized person, and is reasonably likely to cause substantial harm to the individuals to whom the information relates, shall give notice of the breach to each individual. ... Except as provided in subsection (c), the covered entity shall provide notice within 45 days ...”
106. Alabama Legislature. Code of Alabama 1975, § 8-38-6, Notice of Security Breach - Attorney General. “(a) If the number of individuals a covered entity is required to notify under Section 8-38-5 exceeds 1,000, the entity shall provide written notice of the breach to the Attorney General ...” Checked October 30, 2026.
107. Alabama Legislature. Code of Alabama 1975, § 8-38-11, Exemptions - Federal. Checked October 30, 2026.
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     “An entity subject to or regulated by federal laws, rules, regulations, procedures, or guidance on data breach notification established or enforced by the federal government is exempt from this chapter as long as the entity does all of the following: (1) Maintains procedures pursuant to those laws, rules, regulations, procedures, or guidance. (2) Provides notice to affected individuals pursuant to those laws, rules, regulations, procedures, or guidance. (3) Timely provides a copy of the notice to the Attorney General when the number of individuals the entity notified exceeds 1,000.”
108. Alabama Legislature. Code of Alabama 1975, § 26-14-3, Mandatory Reporting. Checked October 30, 2026.
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     “(a)(1) An individual or entity identified in subdivision (2) shall submit an oral report to a law enforcement official or the Department of Human Resources immediately upon knowing or suspecting that a child is a victim of child abuse or neglect, receiving a report from a third party that a child is or is suspected of being a victim of child abuse or neglect, or obtaining any other information that would lead a reasonable person to believe or suspect that a child is a victim of child abuse or neglect. The individual or entity shall submit an additional written report to the official or department within 72 hours of the oral report. ... b. A clinic. ... n. A physical therapist. ... aa. Any other person called upon to render aid or medical assistance to any child.”
109. Alabama Legislature. Code of Alabama 1975, § 27-54A-2, Treatment Under Certain Policies and Contracts (autism spectrum disorder). Checked October 30, 2026.
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     “(9) THERAPEUTIC CARE. Services provided by licensed and certified speech therapists, occupational therapists, or physical therapists. (10) TREATMENT FOR AUTISM SPECTRUM DISORDER. Evidence-based care prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist who determines the care to be medically necessary, including, but not limited to, all of the following: a. Behavioral health treatment. b. Pharmacy care. c. Psychiatric care. d. Psychological care. e. Therapeutic care. ... (b)(1) A health benefit plan shall cover the screening, diagnosis, and treatment of Autism Spectrum Disorder for an insured 18 years of age or under in policies and contracts issued or delivered in the State of Alabama to employers with at least 51 employees for at least 50 percent of its working days during the preceding calendar year. ... (d) Coverage under this section shall not be subject to any limits on the number of visits an individual may make for treatment of autism spectrum disorder.”
110. Alabama Legislature. Code of Alabama 1975, § 27-54A-2, Treatment Under Certain Policies and Contracts (autism spectrum disorder). “Any coverage required under this section, other than the coverage for applied behavior analysis, shall not be subject to the dollar limitations described in this subsection.” Checked October 30, 2026.
111. Centers for Medicare & Medicaid Services. Who are the MACs: A/B MAC Jurisdiction J (JJ). “Contract Awardee: Palmetto GBA, LLC, contract number 75FCMC24C0023 ... JJ processes FFS Medicare Part A and Part B claims for Alabama, Georgia, and Tennessee ...” Checked October 30, 2026.
112. APTA Alabama. APTA Alabama (the state association's site). Checked October 30, 2026.
113. the Alabama Occupational Therapy Association. the Alabama Occupational Therapy Association (the state association's site). Checked October 30, 2026.
114. the Speech and Hearing Association of Alabama. the Speech and Hearing Association of Alabama (the state association's site). Checked October 30, 2026.
115. DrSensory. Occupational therapy clinics in Alabama, with the physical therapy and speech therapy pages for the state (the directory's state pages, built from the addresses it holds). Checked October 30, 2026.
116. DrSensory. Clinic Directory Pricing. “Claiming your listing is free. The subscription is $349.99 a year or $29.99 a month for your first location, and $99.99 a year or $9.99 a month for each additional location, not per therapist.” Checked October 30, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. It is general guidance on running a therapy clinic in Alabama, not legal, compliance, billing or financial advice. Rules change; the clinic confirms each with its source before acting on it.