Missouri PT, OT and SLP guide

For OT, PT and SLP clinics in Missouri: two state boards license the disciplines, a physical therapist with a doctorate of physical therapy degree or five years of clinical practice may evaluate and initiate treatment without a referral, MO HealthNet 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 Missouri?

Two state boards license the three disciplines in Missouri, 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 Missouri Board of Registration for the Healing Arts, with its Advisory Commission for Physical Therapists.⁠^{1,37,38,39,40,41,42,43} Occupational therapists and occupational therapy assistants answer to the Missouri Board of Occupational Therapy.⁠^{6,44,45,46,47,48,49,50} Speech-language pathologists answer to the Missouri Board of Registration for the Healing Arts, with its Advisory Commission for Speech-Language Pathologists and Audiologists.⁠^{7,51,52,53,54,55,56,57,58} The State Board of Registration for the Healing Arts is the board under the physical therapy act, and its Advisory Commission for Physical Therapists, four physical therapists and one physical therapist assistant, guides, advises and makes recommendations to the board.⁠^{1,37,38,39,40,41,42,43} Speech-language pathologists are licensed under the State Board of Registration for the Healing Arts, which its Advisory Commission for Speech-Language Pathologists and Audiologists guides, advises and makes recommendations to; three of the commission members are licensed speech-language pathologists and three are licensed audiologists.⁠^{7,51,52,53,54,55,56,57,58} 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 a Missouri 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 a Missouri 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, a physical therapist with a doctorate of physical therapy degree or five years of clinical practice as a physical therapist may evaluate and initiate treatment without a prescription or referral; the therapist must refer to an approved health care provider a patient whose condition is beyond the scope of physical therapy, or who shows no measurable or functional improvement after ten visits or thirty days, whichever comes first, and must consult an approved health care provider after every ten visits or thirty days before continuing care for a patient who is improving; the consultation requirement does not apply to physical therapy in a primary or secondary school for individuals 21 or younger, and no physical therapist may make a medical diagnosis.⁠^{2,8,9,10,11,12} MO HealthNet, as a payer, follows the same rule: an enrolled physical therapist with a Doctor of Physical Therapy degree or five years of clinical practice may evaluate and initiate treatment without a prescription from a primary care provider, and the therapist’s own NPI goes on the claim as the ordering provider.⁠^{2,8,9,10,11,12} For occupational therapy, the Occupational Therapy Practice Act defines occupational therapy as the use of purposeful activity or interventions designed to achieve functional outcomes, and requires a license or permit to practice it.⁠^59,60,61,62 MO HealthNet, as a payer, requires the ordering provider’s NPI on occupational therapy claims and denies a claim without it or from an ordering provider not enrolled with MO HealthNet. For school-based IEP services, an enrolled occupational therapist may evaluate and initiate treatment without a prescription or referral from a primary care provider, working within the scope of practice under state law.⁠^59,60,61,62 For speech-language pathology, the licensure act defines the practice of speech-language pathology, including screening, assessment, diagnosis and treatment of speech, language, swallowing and related disorders, and requires a license to practice it.⁠^63,64,65,66 MO HealthNet, as a payer, requires the referring provider’s NPI on speech-language therapy claims and denies a claim without it or from a referring provider not enrolled with MO HealthNet. For school-based IEP services, an enrolled speech-language pathologist may evaluate and initiate treatment without a prescription or referral from a primary care provider, and a written referral or prescription is no longer needed.⁠^63,64,65,66

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.⁠²⁸ MO HealthNet’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 MO HealthNet pay for pediatric and adult therapy?

MO HealthNet is Missouri’s Medicaid program, run by the MO HealthNet Division of the Missouri Department of Social Services, and a clinic enrolls through its provider enrollment route before it bills.⁠⁶⁷ 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.⁠⁶⁸ MO HealthNet covers physical, occupational and speech-language therapy for members under 21 when it is medically necessary and the need is found during a Healthy Children and Youth (HCY) screening, an IEP or an IFSP. The HCY Program is Missouri’s Early Periodic, Screening, and Diagnostic Treatment program, and evaluations are covered up to four hours per discipline per child, per provider, in a 12-month period.⁠^3,4,5

For adults 21 and older in the assistance categories for pregnant women, blind and skilled nursing facility residents, MO HealthNet covers physical therapy in the Hospital Program, and outpatient hospital occupational and speech therapy when needed for adaptive training to use an orthotic or prosthetic device. Its limited therapy program, available regardless of age, covers occupational therapy for adaptation to an orthotic or prosthetic device and speech-language therapy for adaptation to an artificial larynx, limited to adaptive training in connection with receiving the device. Habilitative physical, occupational and speech therapy is covered for the adult expansion group (ME code E2), limited to 20 visits in all per rolling year across providers, except that E2 members aged 19 and 20 may receive all medically necessary habilitative therapy, and no prior authorization is required.⁠^{13,14,15,16,17} MO HealthNet does not require prior authorization for physical, occupational or speech-language therapy evaluation or treatment; services follow the member’s plan of care within the manual’s limits, and augmentative communication devices and ACD training need pre-certification.⁠^69,70 A child through age 18, a parent or guardian with a child under 19 in the home, an adult 19 to 64 without a disability and a pregnant woman get MO HealthNet through one of the managed care health plans, Healthy Blue, United Healthcare or Home State Health, and certain individuals through Show Me Healthy Kids. A person with a disability, a senior 65 or older, a blind or visually impaired adult and a woman under 65 with breast or cervical cancer are in the Fee-For-Service program. The managed care plans must provide medically necessary therapy to children under 21, but therapy in a First Steps IFSP is paid fee-for-service by MO HealthNet, not by the plan.⁠^71,72,73,74 The fee schedule is published by the agency, and a clinic reads the current file rather than a remembered rate.⁠⁷⁵

How does MO HealthNet want OT, PT and SLP claims coded?

MO HealthNet pays therapy fee-for-service at the lower of the billed charge or its maximum allowable amount. One unit of a 15-minute timed CPT code needs at least eight minutes of the service, following Medicare’s rounding, and PT, OT and SLT evaluation codes may not be billed at the same time. Group physical and occupational therapy is not covered, speech-language therapy records must say whether therapy was group or individual, and claims carry modifier TL for First Steps IFSP services, TM or TR for IEP services, 96 for habilitative services and HE for occupational therapy for behavioral health.⁠^{76,77,78,79,80} 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 MO HealthNet pay for therapy in schools?

In the School-Based IEP Direct Services program for public and charter schools, a school district enrolls as a MO HealthNet billing provider and is reimbursed on a cost basis at the federal financial participation rate for therapy identified in a student’s IEP, only up to the amount and duration the IEP states, with the remainder of the cost the district’s responsibility. Each therapist and therapy assistant who delivers the services also enrolls as a performing provider.⁠^{81,82,83,84,85} 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 MO HealthNet cover therapy by telehealth?

MO HealthNet authorizes any licensed, enrolled health care professional to provide telemedicine services within the scope of the license and with the same standard of care as in person. A school district providing telehealth on school grounds bills with the GT modifier.⁠^86,87 The telehealth section below covers the state’s own rules for the session itself.

What are Missouri’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.⁠¹⁸ Missouri’s telehealth law authorizes any licensed health care provider, a term that takes the insurance code’s definition covering a physician or other health care practitioner licensed by the state of Missouri, to provide telehealth services within the scope of the license and with the same standard of care as in person, and requires a provider treating patients in Missouri by telehealth to be fully licensed in Missouri and regulated by the provider’s own board. Telehealth includes audiovisual and audio-only technology.⁠^88,89,90,91

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.⁠^19,20,21 Missouri requires health carriers and health benefit plans to cover a service delivered through telehealth if they would cover it face to face, to reimburse it on the same basis as in person, subject to correct coding, and to charge no greater deductible, copayment or coinsurance. A plan may limit telehealth coverage to providers in its network.⁠^92,93,94

Which business steps are specific to Missouri?

The entity is registered with the Corporations Unit of the Missouri Secretary of State’s Business Services Division, and the choice of entity is shaped by the state’s rule on who may own a therapy business.⁠³⁰ Missouri’s professional corporation law defines the professional services a professional corporation renders by a list of professions, and physical therapists are on the list.⁠³¹ State tax registration is with the Missouri Department of Revenue, through its online registration system or Form 2643.⁠⁹⁵ Missouri’s sales tax rule says a sale of tangible personal property is taxed unless a specific statute exempts it, and a sale of a service is not taxed unless a specific statute authorizes it. When tangible personal property and a nontaxable service are sold separately, the property is subject to tax and the service is not. A business making sales of tangible personal property or taxable services obtains a sales tax license from the Department of Revenue.⁠^96,97 Missouri requires an employer with five or more employees to carry workers’ compensation insurance, or one or more in the construction industry. Sole proprietors and partners are not covered unless they elect coverage, while family member employees and LLC members are presumed covered unless they opt out.⁠⁹⁸ 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 Missouri?

As a MO HealthNet requirement, providers must keep the fiscal and medical records that fully document services billed to MO HealthNet for at least six years from the date of service, or as a specific provider manual indicates, and make them available for inspection or audit on request.⁠²⁹ 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.⁠^99,100

Missouri requires physicians, chiropractors, hospitals, dentists and other duly licensed practitioners to give a patient, or the patient’s guardian or legally authorized representative, a copy of the patient’s health history and treatment record on written request, limited to access consistent with the patient’s condition and sound therapeutic treatment as the provider determines.⁠¹⁰¹ Missouri’s breach notification law requires a person that owns or licenses personal information of Missouri residents, a term whose definition includes medical information and health insurance information, to notify affected consumers of a breach of security without unreasonable delay, and to notify the attorney general’s office and the nationwide consumer reporting agencies when more than one thousand consumers are notified at one time. A person regulated by state or federal law that follows its regulator’s breach procedures is deemed in compliance.⁠^{102,103,104,105} Missouri requires physicians, nurses, hospital or clinic personnel engaged in the examination, care or treatment of persons, any other health practitioner and the other persons the statute lists who have reasonable cause to suspect a child has been or may be subjected to abuse or neglect to report immediately to the Children’s Division. A separate statute names physical therapists, hospital and clinic personnel and other health practitioners among those who must immediately report suspected abuse or neglect of an eligible adult to the Department of Health and Senior Services.⁠^{106,107,108,109}

Which Missouri rules shape a pediatric clinic?

First Steps is Missouri’s early intervention system for infants and toddlers from birth to age three with delayed development or diagnosed conditions associated with developmental disabilities, with the Department of Elementary and Secondary Education as the lead state agency and Part C of IDEA as its governing federal law. A referral is made online, by calling 866-583-2392 extension 3 to reach the System Point of Entry (SPOE) for the area, or with a General Referral Form sent to the SPOE where the child lives, and providers enroll as First Steps providers through the Central Finance Office contracted with the department. Missouri also requires health benefit plans other than Medicaid plans to cover early intervention speech and language, occupational and physical therapy and assistive technology for children from birth to age three found eligible for Part C, up to three thousand dollars per child per policy per calendar year, with a maximum of nine thousand dollars per child.⁠^{32,33,34,35,36} 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. Missouri requires health benefit plans delivered, issued, continued or renewed on or after January 1, 2020 to cover diagnosis and treatment of autism spectrum disorders and of developmental or physical disabilities, including therapeutic care by licensed speech therapists, occupational therapists or physical therapists, when medically necessary and ordered by the treating physician or psychologist under a treatment plan. Applied behavior analysis has a maximum benefit of forty thousand dollars per calendar year through age 18, which may be exceeded with the plan’s prior approval when medically necessary, coverage other than applied behavior analysis is not subject to those age and dollar limits, and therapeutic care for developmental or physical disabilities may be limited to a number of visits a year unless the plan approves more as medically necessary. The law does not apply to MO HealthNet.⁠^{110,111,112,113,114,115} The autism insurance mandates guide covers how such a mandate meets a plan’s own terms. Missouri’s Children and Youth with Special Health Care Needs Program serves Missouri residents from birth to age 21 with an eligible special health care need. It provides service coordination to every participant and, as payor of last resort, limited funding for medically necessary diagnostic and treatment services, which may include physical, occupational and speech therapy, for participants whose family income is at or below 185% of the Federal Poverty Guidelines.⁠^116,117

Which Missouri rules shape an adult clinic?

Medicare claims from Missouri go to Wisconsin Physicians Service Government Health Administrators, the Medicare Administrative Contractor for Jurisdiction 5, Parts A and B (Iowa, Kansas, Missouri and Nebraska), whose local coverage articles for therapy are the ones a Missouri clinic reads.⁠¹¹⁸ MO HealthNet’s adult therapy rules are in the Medicaid section above.

Which associations and directory pages serve Missouri?

The state chapters are the Missouri Physical Therapy Association (MPTA) for physical therapy, the Missouri Occupational Therapy Association (MOTA) for occupational therapy and the Missouri Speech-Language-Hearing Association (MSHA) for speech-language pathology.⁠^119,120,121 On DrSensory, families browse Missouri 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.⁠¹²²

Which Missouri cities have DrSensory city pages?

Beyond its three Missouri pages, the directory publishes city pages for 2 Missouri cities, 6 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.⁠¹²²

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

DrSensory lists 70 PT, OT and SLP clinics in Missouri, on its occupational therapy, physical therapy and speech therapy pages for the state.⁠¹²²

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

Which templates does a Missouri launch need?

How might two Missouri clinics plan a launch?

Sources

1. Missouri Division of Professional Registration. Missouri Board of Registration for the Healing Arts, with its Advisory Commission for Physical Therapists. Checked October 30, 2026.
2. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 334.506: Physical therapists may provide certain services without prescription or direction of an approved health care provider. Checked October 30, 2026.
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   “2. A physical therapist may evaluate and initiate treatment on a patient without a prescription or referral from an approved health care provider, provided that the physical therapist has a doctorate of physical therapy degree or has five years of clinical practice as a physical therapist. 3. A physical therapist may provide educational resources and training, develop fitness or wellness programs, or provide screening or consultative services within the scope of physical therapy practice without a prescription or referral from an approved health care provider. 4. (1) A physical therapist shall refer to an approved health care provider any patient whose condition at the time of evaluation or treatment is determined to be beyond the scope of practice of physical therapy. The physical therapist shall not provide physical therapy services or treatment after this referral has been made. (2) A physical therapist shall refer to an approved health care provider any patient who does not demonstrate measurable or functional improvement after ten visits or thirty days, whichever occurs first. The physical therapist shall not provide further therapy services or treatment after this referral has been made.”
3. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. Checked October 30, 2026.
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   “PT, OT, and SLT services are covered for persons under age 21 when medically necessary and when the need for treatment is found during an HCY screening service (full, partial, or interperiodic), IEP, or IFSP as stated in Section 2.10 and Section 2.11 of this manual.”
4. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Hospital Provider Manual (published August 11, 2026). “The HCY Program is Missouri’s Early Periodic, Screening, and Diagnostic Treatment program.” Checked October 30, 2026.
5. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. “Evaluations for PT, OT, and SLT do not require prior authorization. Four (4) hours of evaluation per discipline for a child (per provider) are covered within a 12-month period.” Checked October 30, 2026.
6. Missouri Division of Professional Registration. Missouri Board of Occupational Therapy. Checked October 30, 2026.
7. Missouri Division of Professional Registration. Missouri Board of Registration for the Healing Arts, with its Advisory Commission for Speech-Language Pathologists and Audiologists. Checked October 30, 2026.
8. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 334.506: Physical therapists may provide certain services without prescription or direction of an approved health care provider. Checked October 30, 2026.
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   “(3) (a) A physical therapist shall consult with an approved health care provider if, after every ten visits or thirty days, whichever occurs first, the patient has demonstrated measurable or functional improvement from the course of physical therapy services or treatment provided and the physical therapist believes that continuation of the course of physical therapy services or treatment is reasonable and necessary based on the physical therapist’s evaluation of the patient. The physical therapist shall not provide further physical therapy services or treatment until the consultation has occurred.”
9. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 334.506: Physical therapists may provide certain services without prescription or direction of an approved health care provider. “(d) The provisions of this subdivision shall not apply to physical therapy services performed within a primary or secondary school for individuals within ages not in excess of twenty-one years.” Checked October 30, 2026.
10. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 334.506: Physical therapists may provide certain services without prescription or direction of an approved health care provider. “6. No person licensed to practice, or applicant for licensure, as a physical therapist or physical therapist assistant shall make a medical diagnosis.” Checked October 30, 2026.
11. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. “A MO HealthNet enrolled physical therapist may evaluate and initiate treatment without a prescription from a PCP, providing that the physical therapist has a Doctor of Physical Therapy degree or five (5) years of clinical practice as a physical therapist.” Checked October 30, 2026.
12. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. “PT services may be provided without a prescription from a physician. In these situations, the physical therapist is considered the prescribing provider. The MO HealthNet enrolled physical therapist’s NPI number must be included on the claim as the ordering provider.” Checked October 30, 2026.
13. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Hospital Provider Manual (published August 11, 2026). Checked October 30, 2026.
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    “2.12 Therapy Services Physical therapy is covered in the Hospital Program for adult participants age 21 and over, in the assistance categories for pregnant women, blind, and skilled nursing facility (SNF) residents. Occupational and speech therapy are covered in the outpatient hospital setting for adult participants age 21 and over, in the assistance categories for pregnant women, blind, and SNF residents when needed for adaptive training to use an orthotic or prosthetic device.”
14. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Hospital Provider Manual (published August 11, 2026). “2.13 Habilitative Skilled Therapy Services Habilitative skilled therapy (physical, occupational, and speech) services are covered for individuals in a category of assistance for the adult expansion group (Medicaid Eligibility (ME) code: E2).” Checked October 30, 2026.
15. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. Checked October 30, 2026.
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    “Limitations The combination of all habilitative skilled therapy services for participants is limited to a total of 20 visits per rolling year, inclusive of services from all MO HealthNet providers. Participants ages 19 to 20 with ME code E2 may receive all medically necessary habilitative skilled therapy services. Prior authorization is not required.”
16. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. “SLT for adaptation to the use of an artificial larynx is covered by MO HealthNet’s limited therapy program available to participant’s regardless of age. The coverage is limited to adaptive training in connection with the receipt of an artificial larynx.” Checked October 30, 2026.
17. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. Checked October 30, 2026.
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    “OT for adaptation to the use of an orthotic or prosthetic device is covered by MO HealthNet’s limited therapy program available to participant’s regardless of age. The coverage is limited to adaptive training in connection with the receipt of the device. Adaptive therapy may be provided by rehabilitation center providers, outpatient hospital providers, and home health agencies.”
18. 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”.
19. PT Compact Commission. PT Compact Map. “Member States (38) ... Mississippi Missouri Montana ...” Checked October 30, 2026.
20. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 334.1200: Physical Therapy Licensure Compact, purpose. “The purpose of this compact is to facilitate interstate practice of physical therapy with the goal of improving public access to physical therapy services.” Checked October 30, 2026.
21. Missouri Division of Professional Registration. Physical Therapists: PT / PTA Compact. “Physical Therapists and Physical Therapist Assistants Compact Privilege holders are required to complete a jurisprudence examination before purchasing a compact privilege.” Checked October 30, 2026.
22. 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? ... Missouri October 26, 2026 MO Jurisprudence Information MO OT Practice Act ...” Checked October 30, 2026.
23. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 324.087: Occupational Therapy Licensure Compact. “The purpose of this Compact is to facilitate interstate practice of Occupational Therapy with the goal of improving public access to Occupational Therapy services.” Checked October 30, 2026.
24. Missouri Board of Occupational Therapy. Missouri OT/OTA Compact (board FAQ). “Missouri became an active member of the OT Compact on October 26, 2026.” Checked October 30, 2026.
25. Audiology and Speech-Language Pathology Interstate Compact Commission. Delegate Information. “Member State Appointed Delegates ... Missouri Audiology Appointment Pending Missouri SLP Sara Steele ...” Checked October 30, 2026.
26. 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. As more member states launch, the ASLP-IC Home Page and Compact Map will be updated.” Checked October 30, 2026.
27. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 345.085: Audiology and speech-language pathology compact. “The purpose of this Compact is to facilitate interstate practice of audiology and speech-language pathology with the goal of improving public access to audiology and speech-language pathology services.” Checked October 30, 2026.
28. 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.”.
29. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet General Sections Provider Manual. Checked October 30, 2026.
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    “From the date of service, MO HealthNet providers must retain fiscal and medical records that coincide with and fully document services billed to MHD for at least six (6) years or as otherwise indicated in specific Provider Manuals, and must furnish or make the records available for inspection or audit by the Department of Social Services (DSS), MMAC, or its representative upon request.”
30. Missouri Secretary of State. Corporations. Checked October 30, 2026.
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    “The Corporations Unit of the Secretary of State is responsible for the creation and maintenance filings for all domestic and out-of-state business entities doing business in Missouri. These business entities include for-profit and nonprofit corporations, specialized business entities such as professional corporations, close corporations, agricultural cooperatives and mutual associations, and limited liability companies, limited partnerships and others.”
31. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 356.021: Definitions (professional corporations). Checked October 30, 2026.
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    “(5) "Professional service" and "professional services": (a) Any service that lawfully may be rendered only by persons licensed under the provisions of a licensing law of this state and that also may not lawfully be rendered by a corporation organized under the general and business corporation law of Missouri, chapter 351; and (b) Practiced by the following professionals, each subparagraph constituting one type: a. An accountant; b. An architect or engineer; c. An attorney at law; d. A chiropodist-podiatrist; e. A chiropractor; f. A dentist; g. An optometrist; h. A physician, surgeon, doctor of medicine or doctor of osteopathy; i. A psychologist; j. A veterinarian; k. A registered nurse; l. Any natural person licensed as a real estate salesperson; m. A physical therapist ...”
32. Missouri Department of Elementary and Secondary Education. First Steps. Checked October 30, 2026.
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    “First Steps is Missouri’s Early Intervention system for infants and toddlers, birth to age three, who have delayed development or diagnosed conditions that are associated with developmental disabilities. The federal law governing First Steps is Part C of the Individuals with Disabilities Education Act (IDEA). The Department of Elementary and Secondary Education (DESE) is the lead state agency responsible for implementing the First Steps program.”
33. Missouri Department of Elementary and Secondary Education. First Steps: How to Make a Referral. Checked October 30, 2026.
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    “Make a Referral Enter a referral online Call 866-583-2392 Ext. 3 to be connected to the SPOE in your area, or visit the SPOE Regions Map to find the contact information for the SPOE in your area. Complete a General Referral Form and send it to the SPOE office where the child lives ...”
34. Missouri Department of Elementary and Secondary Education. First Steps: How to Make a Referral. Checked October 30, 2026.
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    “Children between the ages of birth to 36 months who either 1) have a diagnosed physical or mental condition associated with developmental disabilities (such as Down syndrome, spina bifida or cerebral palsy), or 2) have a condition associated with a high probability of resulting in a developmental delay or disability (such as a very low birth weight child who has experienced intracranial bleeding or ventilator dependency), or 3) are functioning at half the developmental level expected for a child of equal age in one or more of the following areas: communication, adaptive, physical (including vision and hearing), cognitive or social/emotional.”
35. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. “Providers must be enrolled as First Steps providers through the Central Finance Office (CFO) contracted with DESE.” Checked October 30, 2026.
36. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 376.1218: Insurance coverage for children enrolled in the Part C early intervention system (First Steps). Checked October 30, 2026.
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    “1. Any health carrier or health benefit plan that offers or issues health benefit plans, other than Medicaid health benefit plans, which are delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2006, shall provide coverage for early intervention services described in this section that are delivered by early intervention specialists who are health care professionals licensed by the state of Missouri and acting within the scope of their professions for children from birth to age three identified by the Part C early intervention system as eligible for services under Part C of the Individuals with Disabilities Education Act, 20 U.S.C. Section 1431, et seq. Such coverage shall be limited to three thousand dollars for each covered child per policy per calendar year, with a maximum of nine thousand dollars per child. ... 4. For purposes of this section, "early intervention services" means medically necessary speech and language therapy, occupational therapy, physical therapy, and assistive technology devices for children from birth to age three who are identified by the Part C early intervention system as eligible for services under Part C of the Individuals with Disabilities Education Act, 20 U.S.C. Section 1431, et seq.”
37. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 334.500: Definitions. “(1) "Board", the state board of registration for the healing arts in the state of Missouri ...” Checked October 30, 2026.
38. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 334.625: Advisory commission for physical therapists created, powers and duties. Checked October 30, 2026.
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    “1. There is hereby established an "Advisory Commission for Physical Therapists" which shall guide, advise and make recommendations to the board. The commission shall approve the examination required by section 334.530 and shall assist the board in carrying out the provisions of sections 334.500 to 334.620. 2. The commission shall be appointed no later than October 1, 1989, and shall consist of five members appointed by the director of the division of professional registration. Each member shall be a citizen of the United States and a resident of this state and four shall be licensed as physical therapists by this state, and one shall be licensed as a physical therapist assistant by this state.”
39. Missouri Secretary of State, Code of State Regulations. 20 CSR 2150-3: Licensing of Physical Therapists and Physical Therapist Assistants. Checked October 30, 2026.
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    “20 CSR 2150-3.060 Biennial Registration PURPOSE: This rule provides information to professional physical therapists permanently licensed in Missouri regarding biennial registration. (1) Each applicant shall renew the registration with the board upon a form furnished by the board before January 31 of the year the license is due for renewal.”
40. Missouri Secretary of State, Code of State Regulations. 20 CSR 2150-3: Licensing of Physical Therapists and Physical Therapist Assistants. Checked October 30, 2026.
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    “(1) All licensed physical therapists and physical therapist assistants shall biennially, on even-numbered years, complete and report at least thirty (30) hours of acceptable continuing education as specified in rule 20 CSR 2150-3.203. The renewal of a license which has lapsed shall not be issued unless and until the licensee submits documentation confirming completion of all continuing education hours as would have been necessary and applicable during the period the license was not current. The continuing education hours must qualify as acceptable continuing education activity as specified in rule 20 CSR 2150-3.203. (2) The period for completion of the continuing education requirements shall be the twenty-four (24)-month period beginning January 1 and ending December 31 of each reporting period.”
41. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 334.507: Continuing education requirements. Checked October 30, 2026.
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    “Each person licensed pursuant to sections 334.500 to 334.685 shall accumulate thirty hours of continuing education every two years to be eligible for relicensure, as follows: (1) Continuing education shall be obtained through courses approved by the Missouri advisory commission for physical therapists and physical therapist assistants; (2) Ten hours of continuing education shall be equivalent to one continuing education unit; (3) Adherence to the continuing education requirement shall be reviewed for licensure renewal in each even-numbered year and shall include all approved continuing education courses taken during the previous two years.”
42. Missouri Secretary of State, Code of State Regulations. 20 CSR 2150-3: Licensing of Physical Therapists and Physical Therapist Assistants. Checked October 30, 2026.
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    “(1) A licensed physical therapist must direct and supervise a physical therapist assistant at all times. ... (3) When supervising the physical therapist assistant, the following requirements must be maintained: (A) The initial visit, evaluation, and treatment plan must be made by a licensed physical therapist; (B) There must be regularly scheduled reassessments of patients by the physical therapist at least every thirty (30) days; (C) There must be conferences with the physical therapist assistant regarding patients, at least weekly or more often, as determined by the complexity and acuity of the patient’s needs. Evidence of conferences with the physical therapist assistant needs to be documented at least every thirty (30) days; (D) A licensed physical therapist must be accessible by telecommunication to the physical therapist assistant at all times while the physical therapist assistant is treating patients ...”
43. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 334.650: Physical therapist assistant, license required, supervision by licensed physical therapist. Checked October 30, 2026.
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    “2. A licensed physical therapist shall direct and supervise a physical therapist assistant. The physical therapist shall retain ultimate authority and responsibility for the physical therapy treatment. The licensed physical therapist shall have the responsibility of supervising the physical therapy treatment program. No physical therapist may establish a treating office in which the physical therapist assistant is the primary care provider. No licensed physical therapist shall have under their direct supervision more than four full-time equivalent physical therapist assistants.”
44. Missouri Division of Professional Registration. Missouri Board of Occupational Therapy: About the Board. Checked October 30, 2026.
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    “Senate Bill 141 created the Missouri Board of Occupational Therapy in 1997. The Board is comprised of six members. Three of the members are occupational therapists, one member is an occupational therapy assistant and the remaining two members represent the interests of the general public.”
45. Missouri Secretary of State, Code of State Regulations. 20 CSR 2205-3: Licensure Requirements (Missouri Board of Occupational Therapy). “(1) All licenses including those on inactive status shall be renewed biennially. Failure of a licensee to renew the license shall cause the license to lapse.” Checked October 30, 2026.
46. Missouri Secretary of State, Code of State Regulations. 20 CSR 2205-5: Continuing Competency Requirements (Missouri Board of Occupational Therapy). Checked October 30, 2026.
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    “(1) At the time of license renewal, the licensee shall verify completion of twenty-four (24) Continuing Competency Credits (CCC) on the renewal form. Failure to note verification of completion shall result in the license not being renewed. Falsification of verification may result in disciplinary action. (2) Each licensee shall retain documentation of the CCCs verified on the renewal form for two (2) years following license renewal.”
47. Missouri Secretary of State, Code of State Regulations. 20 CSR 2205-5: Continuing Competency Requirements (Missouri Board of Occupational Therapy). “(B) One (1) contact hour equals one (1) Continuing Competency Credit ...” Checked October 30, 2026.
48. Missouri Secretary of State, Code of State Regulations. 20 CSR 2205-4: Supervision (Missouri Board of Occupational Therapy). Checked October 30, 2026.
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    “(2) The occupational therapy assistant or occupational therapy assistant limited permit holder may only perform services under the direct supervision of an occupational therapist. (A) The manner of supervision shall depend on the treatment setting, patient/client caseload, and the competency of the occupational therapy assistant and/or occupational therapy assistant limited permit holder as determined by the supervising occupational therapist. At a minimum, supervision shall include consultation of the occupational therapy assistant and/or occupational therapy assistant limited permit holder with the supervising occupational therapist prior to the initiation of any patient’s/client’s treatment plan and modification of treatment plan. (B) More frequent face-to-face supervision may be necessary as determined by the occupational therapist or occupational therapy assistant and/or occupational therapy assistant limited permit holder dependent on the level of expertise displayed by the occupational therapy assistant and/or occupational therapy assistant limited permit holder, the practice setting, and/or the complexity of the patient/client caseload. (C) Supervision shall be an interactive process between the occupational therapist and occupational therapy assistant and/or occupational therapy assistant limited permit holder. It shall be more than peer review or co-signature. The interactive process shall include but is not limited to the patient/client assessment, reassessment, treatment plan, intervention, discontinuation of intervention, and/or treatment plan. (D) The supervising occupational therapist or the supervisor’s designee must be available for immediate consultation with the occupational therapy assistant and/or occupational therapy assistant limited permit holder. The supervisor need not be physically present or on the premises at all times.”
49. Missouri Secretary of State, Code of State Regulations. 20 CSR 2205-4: Supervision (Missouri Board of Occupational Therapy). Checked October 30, 2026.
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    “(D) Not have more than four (4) full-time equivalent (FTE) occupational therapy assistants under his/her supervision at one time; (E) Be responsible for all referrals of the patient/client; (F) Be responsible for completing the patient’s evaluation/assessment. The occupational therapy assistant and/or occupational therapy assistant limited permit holder may contribute to the screening and/or evaluation process by gathering data, administering standardized tests and reporting observations. The occupational therapy assistant and/or occupational therapy assistant limited permit holder may not evaluate independently or initiate treatment before the supervising occupational therapist’s evaluation/assessment ...”
50. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 324.056: License to practice required, when, supervision of occupational therapy assistants. Checked October 30, 2026.
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    “2. A licensed occupational therapy assistant shall be directly supervised by a licensed occupational therapist. The licensed occupational therapist shall have the responsibility of supervising the occupational therapy treatment program. No licensed occupational therapist shall have under his or her direct supervision more than four occupational therapy assistants.”
51. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 345.015: Definitions. “(3) "Board", the state board of registration for the healing arts; (4) "Clinical fellowship", the supervised professional employment period following completion of the academic and practicum requirements of an accredited training program under this chapter; (5) "Commission", the advisory commission for speech-language pathologists and audiologists ...” Checked October 30, 2026.
52. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 345.080: Advisory commission for speech-language pathologists and audiologists established. Checked October 30, 2026.
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    “1. There is hereby established an "Advisory Commission for Speech-Language Pathologists and Audiologists" which shall guide, advise and make recommendations to the board. The commission shall approve the examination required by section 345.050, and shall assist the board in carrying out the provisions of sections 345.010 to 345.075. 2. After August 28, 1997, the commission shall consist of seven members, one of whom shall be a voting public member, appointed by the board of registration for the healing arts. Each member shall be a citizen of the United States and a resident of this state. Three members of the commission shall be licensed speech-language pathologists and three members of the commission shall be licensed audiologists.”
53. Missouri Secretary of State, Code of State Regulations. 20 CSR 2150-4: Licensing of Speech-Language Pathologists and Audiologists. “(4) Effective February 1, 2001, all licenses, except provisional licenses, issued pursuant to Chapter 345, RSMo shall expire biennially in odd-numbered years, with the first renewal cycle beginning February 1, 2001 and ending January 31, 2003.” Checked October 30, 2026.
54. Missouri Secretary of State, Code of State Regulations. 20 CSR 2150-4: Licensing of Speech-Language Pathologists and Audiologists. “Renewal forms postmarked by the post office February 1 or after will be considered delinquent.” Checked October 30, 2026.
55. Missouri Secretary of State, Code of State Regulations. 20 CSR 2150-4: Licensing of Speech-Language Pathologists and Audiologists. Checked October 30, 2026.
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    “(1) Each licensee shall biennially complete and report at least thirty (30) hours of continuing education. A person holding licensure in both speech-language pathology and audiology shall biennially collect and report at least thirty (30) hours of continuing education in speech-language pathology and at least thirty (30) hours in audiology. The board shall not issue a renewal of a licensee’s certificate of registration unless the licensee documents completion of thirty (30) hours of continuing education in the immediately preceding reporting period. (2) The period for completion of the continuing education requirements shall be the twenty-four (24)-month period beginning January 1 and ending December 31 of each reporting period.”
56. Missouri Secretary of State, Code of State Regulations. 20 CSR 2150-4: Licensing of Speech-Language Pathologists and Audiologists. Checked October 30, 2026.
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    “(4) The supervising speech-language pathologist shall have the first initial contact with all patients/clients/students on the assistant’s caseload. Prior to the speech-language pathologist assistant initiating services or therapy, the supervising speech-language pathologist shall gather baseline data and establish an appropriate plan of care for the patient/client/student. The supervising speech-language pathologist shall provide ongoing direct supervision to each assistant a minimum of once every sixty (60) days for each patient/client/student. Direct supervision is defined as real-time observing and viewing the assistant and patient/client/student when the treatment is being provided; direct supervision may be either in-person or through appropriate remote methods.”
57. Missouri Secretary of State, Code of State Regulations. 20 CSR 2150-4: Licensing of Speech-Language Pathologists and Audiologists. Checked October 30, 2026.
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    “(6) The supervising speech-language pathologist shall review and sign all patient/client/student documented progress notes written by the speech-language pathology assistant. (7) The supervising speech-language pathologist shall assign and the assistant shall accept only those duties and respon - sibilities for which the assistant has been specifically trained and is qualified to perform, pursuant to the judgment of the supervising speech-language pathologist, and in compliance with the provisions of Chapter 345, RSMo. (8) The speech-language pathology assistant shall maintain supervisory logs and the speech-language pathologist shall sign verifying the hours of supervision per month; such logs shall be made available to the board within thirty (30) days upon receipt of a request for such logs from the board. (9) The maximum number of speech-language pathology assistants supervised by one (1) speech-language pathologist shall not exceed three (3) at one (1) time.”
58. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 345.015: Definitions. “(12) "Speech-language pathology assistant", a person who is registered as a speech-language pathology assistant by the board, who does not act independently but works under the direction and supervision of a licensed speech-language pathologist practicing for at least one year ...” Checked October 30, 2026.
59. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 324.050: Occupational therapy practice act, definitions. Checked October 30, 2026.
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    “(6) "Occupational therapy", the use of purposeful activity or interventions designed to achieve functional outcomes which promote health, prevent injury or disability and which develop, improve, sustain or restore the highest possible level of independence of any individual who has an injury, illness, cognitive impairment, psychosocial dysfunction, mental illness, developmental or learning disability, physical disability or other disorder or condition.”
60. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 324.056: License to practice required, when, supervision of occupational therapy assistants. Checked October 30, 2026.
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    “1. No person shall practice occupational therapy or hold himself or herself out as an occupational therapist or occupational therapy assistant or as being able to practice occupational therapy, or to render occupational therapy services in this state unless such person is licensed or holds a valid permit pursuant to sections 324.050 to 324.089.”
61. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. Checked October 30, 2026.
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    “Claims for PT and OT services must include the ordering provider’s NPI. These requirements are in accordance with 13 CSR 65-2, 42 CFR 455.410, and 42 CFR 455.440. To comply with the requirements, the claims processing system will deny claims submitted without the OPR provider’s NPI or if the OPR provider is not enrolled with MO HealthNet.”
62. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. Checked October 30, 2026.
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    “For school-based OT services, a MO HealthNet enrolled PCP may prescribe OT evaluation(s) and treatment services. A MO HealthNet enrolled occupational therapist may evaluate and initiate treatment without a prescription or referral from a PCP, providing that the occupational therapist is working in accordance with their scope of practice under state law.”
63. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 345.020: License or registration required to practice. “2. No person shall practice or hold himself or herself out as being able to practice speech-language pathology or audiology in this state unless the person is licensed in accordance with the provisions of sections 345.010 to 345.080.” Checked October 30, 2026.
64. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 345.015: Definitions. Checked October 30, 2026.
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    “(9) "Practice of speech-language pathology": (a) Provides screening, identification, assessment, diagnosis, treatment, intervention, including but not limited to prevention, restoration, amelioration and compensation, and follow-up services for disorders of: a. Speech: articulation, fluency, voice, including respiration, phonation and resonance; b. Language, involving the parameters of phonology, morphology, syntax, semantics and pragmatic; and including disorders of receptive and expressive communication in oral, written, graphic and manual modalities; c. Oral, pharyngeal, cervical esophageal and related functions, such as dysphagia, including disorders of swallowing and oral functions for feeding ...”
65. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. Checked October 30, 2026.
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    “Claims for SLT services must include the referring provider’s NPI. Claims for PT and OT services must include the ordering provider’s NPI. These requirements are in accordance with 13 CSR 65-2, 42 CFR 455.410, and 42 CFR 455.440. To comply with the requirements, the claims processing system will deny claims submitted without the OPR provider’s NPI or if the OPR provider is not enrolled with MO HealthNet.”
66. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. Checked October 30, 2026.
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    “An MO HealthNet-enrolled speech-language pathologists may evaluate and initiate treatment without a prescription or referral from a PCP, providing the speech-language pathologist is working in accordance with their scope of practice under state law. The school district may contract with a PCP for review of evaluation(s) and the IEP to make a determination regarding referral of services. A written referral or prescription is no longer needed for speech-language services.”
67. Missouri Medicaid Audit and Compliance. Provider Enrollment. Checked October 30, 2026.
68. 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.”.
69. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. Checked October 30, 2026.
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    “Prior authorization is not required for PT, OT, and SLT evaluation or treatment services. Providers may provide services in accordance with the participant’s plan of care; however, limits as described in this manual apply. Pre-certification is required for all augmentative communication devices (ACDs) and ACD training.”
70. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. Checked October 30, 2026.
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    “Intensive therapy treatment services consist of PT, OT, and SLT treatment services that exceed one (1) hour and 15 minutes per day or five (5) hours weekly. The provider must have documentation that justifies the medical necessity for intensive therapy services. The following documentation must be available for each date of service that exceeds the limitations: Current therapy evaluation Treatment plan, specifying frequency and duration Documentation for intensive therapy treatment services is not required to be submitted with the claim. The documentation must be kept in the medical record and shall be provided to MHD upon request.”
71. Missouri Department of Social Services. MO HealthNet Benefits & Services. Checked October 30, 2026.
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    “You will get your MO HealthNet coverage through one of the Managed Care Health Plans: Healthy Blue, United Healthcare, or Home State Health if you are a: Parent or guardian with a child under age 19 in the home Child (birth through age 18) Adult age 19-64 without a disability Pregnant woman (including your newborn child)”
72. Missouri Department of Social Services. MO HealthNet Benefits & Services. “You will get your MO HealthNet coverage through the Fee-For-Service program if you are a: Person with a disability Senior (age 65 or older) Blind or visually impaired adult Woman (under age 65) with breast or cervical cancer ...” Checked October 30, 2026.
73. Missouri Department of Social Services. MO HealthNet Benefits & Services. “NOTE: Certain individuals will get their coverage through Show Me Healthy Kids (SMHK).” Checked October 30, 2026.
74. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. Checked October 30, 2026.
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    “MO HealthNet Managed Care health plans are required to provide medically necessary PT, OT, and SLT services to children under age 21. However, PT, OT, and SLT services identified in an IFSP are not the MO HealthNet Managed Care health plan’s responsibility. PT, OT, and SLT services are considered IFSP when included in an IFSP as defined by IDEA, Part C 34 CFR 303. Therapy services are reimbursed on a Fee-For-Service (FFS) basis by MHD when providing IFSP therapy services to Managed Care health plan members.”
75. Missouri Department of Social Services, MO HealthNet Division. Fee Schedules & Rate Lists. Checked October 30, 2026.
76. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. Checked October 30, 2026.
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    “Physical therapy (PT), occupational therapy (OT), and speech-language therapy (SLT) services are reimbursed on a Fee-For-Service (FFS) basis. The MO HealthNet Division (MHD) has determined the maximum allowable fee for a unit of service to be a reasonable fee, consistent with efficiency, economy, and quality of care. MHD payment for covered services is the lower of the provider’s actual billed charge or the maximum allowable amount for the date of service billed. Providers may not bill MHD at a higher rate than they charge their private patients. Providers must bill their usual and customary rate. When billing one (1) unit of a 15-minute timed Current Procedure Terminology (CPT) code, the associated modality must be performed for eight (8) minutes at a minimum. MHD follows Medicare’s guidelines for rounding. Providers may not bill PT, OT, and SLT evaluation codes at the same time.”
77. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. “Services are to be provided on an individualized basis for PT and OT services, as MO HealthNet does not provide coverage for group PT or OT sessions.” Checked October 30, 2026.
78. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. Checked October 30, 2026.
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    “OT services are covered as an HCY service for children through age 20 when providing a medically necessary service related to a behavioral health diagnosis that is ordered by an advanced practice registered nurse (APRN), physician, or other practitioner of the healing arts, and is within the scope of the licensed occupational therapists or licensed OT assistants’ practice. The modifier HE must be used with the applicable procedure code and a behavioral health diagnosis included on the claim form.”
79. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. “In accordance with 13 CSR 70-70.010 providers must document the type of therapy given, i.e., group or individual therapy.” Checked October 30, 2026.
80. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. Checked October 30, 2026.
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    “TL IFSP services for participants participating in First Steps. Refer to Section 2.11 in this manual for more information. TM IEP services when the public school district originates the IEP. Refer to Section 2.10 in this manual for more information. TR IEP services when the services are being provided by or for a school district outside the school district originating the IEP (e.g., private agency, cooperative, etc.). Refer to Section 2.10 in this manual for more information. 96 Habilitative services.”
81. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. Checked October 30, 2026.
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    “OT, PT, and SLT services are included in the MO HealthNet School-Based Individualized Education Plan (IEP) Direct Services program (hereafter referred to as direct services) for public and charter schools. The program allows school districts to receive the federal match portion of the funds allocated for certain medical services that are also provided as part of an IEP for children with disabilities.”
82. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. “Each school district interested in billing MHD for school-based therapy services must enroll as a MO HealthNet billing provider.” Checked October 30, 2026.
83. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. “Only the services identified in the IEP are reimbursable my MO HealthNet and only up to the amount and duration indicated in the IEP.” Checked October 30, 2026.
84. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. “Direct services provided as documented in an IEP are reimbursed on a cost basis at the Federal Financial Participation Rate (FFP). The remainder of the cost is the responsibility of the school district originating the IEP.” Checked October 30, 2026.
85. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. “Each individual therapist and therapy assistant who provides OT, PT, or SLT services for a school district must also enroll with MO HealthNet as a performing provider.” Checked October 30, 2026.
86. Missouri Secretary of State, Code of State Regulations. 13 CSR 70-3.330: Telemedicine Services (MO HealthNet). Checked October 30, 2026.
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    “(A) Any licensed/enrolled health care professional shall be authorized to provide telemedicine services if such services to MHD participants are within the scope of practice for which the health care provider is licensed and are provided with the same standard of care as services provided in person.”
87. Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Therapy Provider Manual. “If a school district is providing telehealth services on school grounds, the GT modifier must be used.” Checked October 30, 2026.
88. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 191.1145: Definitions, telehealth services authorized, when. Checked October 30, 2026.
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    “2. Any licensed health care provider shall be authorized to provide telehealth services if such services are within the scope of practice for which the health care provider is licensed and are provided with the same standard of care as services provided in person. This section shall not be construed to prohibit a health carrier, as defined in section 376.1350, from reimbursing nonclinical staff for services otherwise allowed by law. 3. In order to treat patients in this state through the use of telemedicine or telehealth, health care providers shall be fully licensed to practice in this state and shall be subject to regulation by their respective professional boards.”
89. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 191.1145: Definitions, telehealth services authorized, when. “(4) "Health care provider", as that term is defined in section 376.1350 ...” Checked October 30, 2026.
90. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 376.1350: Definitions. “(19) "Health care professional", a physician or other health care practitioner licensed, accredited or certified by the state of Missouri to perform specified health services consistent with state law; (20) "Health care provider" or "provider", a health care professional or a facility ...” Checked October 30, 2026.
91. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 191.1145: Definitions, telehealth services authorized, when. Checked October 30, 2026.
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    “(6) "Telehealth" or "telemedicine", the delivery of health care services by means of information and communication technologies, including audiovisual and audio-only technologies, which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site.”
92. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 376.1900: Definitions, reimbursement for telehealth services, when. Checked October 30, 2026.
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    “4. A health carrier shall not be required to reimburse a telehealth provider or a consulting provider for site origination fees or costs for the provision of telehealth services; however, subject to correct coding, a health carrier shall reimburse a health care provider for the diagnosis, consultation, or treatment of an insured or enrollee when the health care service is delivered through telehealth on the same basis that the health carrier covers the service when it is delivered in person. 5. A health care service provided through telehealth shall not be subject to any greater deductible, co-payment, or coinsurance amount than would be applicable if the same health care service was provided through face-to-face diagnosis, consultation, or treatment.”
93. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 376.1900: Definitions, reimbursement for telehealth services, when. Checked October 30, 2026.
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    “2. Each health carrier or health benefit plan that offers or issues health benefit plans which are delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2014, shall not deny coverage for a health care service on the basis that the health care service is provided through telehealth if the same service would be covered if provided through face-to-face diagnosis, consultation, or treatment.”
94. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 376.1900: Definitions, reimbursement for telehealth services, when. “8. A health carrier or health benefit plan may limit coverage for health care services that are provided through telehealth to health care providers that are in a network approved by the plan or the health carrier.” Checked October 30, 2026.
95. Missouri Department of Revenue. Business Tax Registration. Checked October 30, 2026.
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    “A business must obtain a sales tax license by registering with the Department of Revenue if it’s making sales of tangible personal property and taxable services (such as telephone service and fees paid into places of amusement including but not limited to yoga and fitness centers). A business should also register with the department if it is a corporation responsible for filing and paying corporate tax or if it has employees and is required to remit withholding tax. ... To register a business, utilize the online registration system or submit a Missouri Tax Registration Application (Form 2643).”
96. Missouri Secretary of State, Code of State Regulations. 12 CSR 10-103.600: Sales of Tangible Personal Property and Services. Checked October 30, 2026.
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    “(1) In general, the sale of tangible personal property is subject to tax unless a specific statute exempts it. The sale of a service is not subject to tax unless a specific statute authorizes the taxation of the service. When a sale involves both tangible personal property and a nontaxable service, the sale of the tangible personal property will be subject to tax, and the service will not be subject to tax, if the sale of each is separate.”
97. Missouri Department of Revenue. Business Tax Registration. “A business must obtain a sales tax license by registering with the Department of Revenue if it’s making sales of tangible personal property and taxable services (such as telephone service and fees paid into places of amusement including but not limited to yoga and fitness centers).” Checked October 30, 2026.
98. Missouri Department of Labor and Industrial Relations, Division of Workers’ Compensation. Employers, Insurers, and TPAs. Checked October 30, 2026.
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    “In the state of Missouri you are required to carry workers’ compensation insurance if you have five or more employees, unless you are in the construction industry, then you must carry workers’ compensation insurance if you have one or more employees. Employers that don’t have the required number of employees or who have employees in the exempt categories may “elect” to come under the law and carry workers’ compensation insurance. Exempt employers that decide not to purchase workers compensation insurance or to self-insure remain exposed to civil lawsuits brought by employees who are injured during work. Sole proprietors and partners are not themselves covered unless they elect to be covered; close family member-employees and members of a limited liability company are presumed to be covered unless they opt out.”
99. 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.”.
100. 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.”.
101. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 191.227: Medical records to be released to patient, when. Checked October 30, 2026.
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     “1. All physicians, chiropractors, hospitals, dentists, and other duly licensed practitioners in this state, herein called "providers", shall, upon written request of a patient, or guardian or legally authorized representative of a patient, furnish a copy of his or her record of that patient’s health history and treatment rendered to the person submitting a written request, except that such right shall be limited to access consistent with the patient’s condition and sound therapeutic treatment as determined by the provider.”
102. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 407.1500: Definitions, notice to consumer for breach of security. Checked October 30, 2026.
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     “2. (1) Any person that owns or licenses personal information of residents of Missouri or any person that conducts business in Missouri that owns or licenses personal information in any form of a resident of Missouri shall provide notice to the affected consumer that there has been a breach of security following discovery or notification of the breach. The disclosure notification shall be: (a) Made without unreasonable delay ...”
103. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 407.1500: Definitions, notice to consumer for breach of security. “(e) Medical information; or (f) Health insurance information.” Checked October 30, 2026.
104. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 407.1500: Definitions, notice to consumer for breach of security. Checked October 30, 2026.
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     “(8) In the event a person provides notice to more than one thousand consumers at one time pursuant to this section, the person shall notify, without unreasonable delay, the attorney general’s office and all consumer reporting agencies that compile and maintain files on consumers on a nationwide basis, as defined in 15 U.S.C. Section 1681a(p), of the timing, distribution, and content of the notice.”
105. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 407.1500: Definitions, notice to consumer for breach of security. Checked October 30, 2026.
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     “(2) A person that is regulated by state or federal law and that maintains procedures for a breach of the security of the system pursuant to the laws, rules, regulations, guidances, or guidelines established by its primary or functional state or federal regulator is deemed to be in compliance with this section if the person notifies affected consumers in accordance with the maintained procedures when a breach occurs.”
106. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 210.115: Reports of abuse, neglect, and under age eighteen deaths, persons required to report. Checked October 30, 2026.
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     “1. When any physician, medical examiner, coroner, dentist, chiropractor, optometrist, podiatrist, resident, intern, nurse, hospital or clinic personnel that are engaged in the examination, care, treatment or research of persons, and any other health practitioner, psychologist, mental health professional, social worker, day care center worker or other child-care worker, juvenile officer, probation or parole officer, jail or detention center personnel, teacher, principal or other school official, minister as provided by section 352.400, peace officer or law enforcement official, volunteer or personnel of a community service program that offers support services for families in crisis to assist in the delegation of any powers regarding the care and custody of a child by a properly executed power of attorney pursuant to sections 475.600 to 475.604, or other person with responsibility for the care of children has reasonable cause to suspect that a child has been or may be subjected to abuse or neglect or observes a child being subjected to conditions or circumstances which would reasonably result in abuse or neglect, that person shall immediately report to the division in accordance with the provisions of sections 210.109 to 210.183.”
107. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 210.110: Definitions (child abuse). “(7) "Division", the Missouri children’s division within the department of social services ...” Checked October 30, 2026.
108. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 192.2405: Mandatory reporters, penalty for failure to report. Checked October 30, 2026.
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     “1. The following persons shall be required to immediately report or cause a report to be made to the department under sections 192.2400 to 192.2470: ... hospital and clinic personnel engaged in the care or treatment of others, ... other health practitioner, peace officer, pharmacist, physical therapist, physician, ... who has reasonable cause to suspect that the eligible adult has been subjected to abuse or neglect or observes the eligible adult being subjected to conditions or circumstances which would reasonably result in abuse or neglect.”
109. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 192.2400: Definitions (adult abuse and neglect). “(4) "Department", the department of health and senior services ...” Checked October 30, 2026.
110. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 376.1224: Autism spectrum disorders and developmental or physical disabilities, insurance coverage required. Checked October 30, 2026.
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     “2. Except as otherwise provided in subsection 12 of this section, all health benefit plans that are delivered, issued for delivery, continued, or renewed on or after January 1, 2020, if written inside the state of Missouri, or written outside the state of Missouri but insuring Missouri residents, shall provide coverage for the diagnosis and treatment of autism spectrum disorders and for the diagnosis and treatment of developmental or physical disabilities to the extent that such diagnosis and treatment is not already covered by the health benefit plan.”
111. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 376.1224: Autism spectrum disorders and developmental or physical disabilities, insurance coverage required. “(13) "Therapeutic care", services provided by licensed speech therapists, occupational therapists, or physical therapists ...” Checked October 30, 2026.
112. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 376.1224: Autism spectrum disorders and developmental or physical disabilities, insurance coverage required. Checked October 30, 2026.
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     “4. (1) Coverage provided under this section for autism spectrum disorder or developmental or physical disabilities is limited to medically necessary treatment that is ordered by the insured’s treating licensed physician or licensed psychologist, pursuant to the powers granted under such licensed physician’s or licensed psychologist’s license, in accordance with a treatment plan.”
113. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 376.1224: Autism spectrum disorders and developmental or physical disabilities, insurance coverage required. Checked October 30, 2026.
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     “5. (1) Coverage provided under this section for applied behavior analysis shall be subject to a maximum benefit of forty thousand dollars per calendar year for individuals through eighteen years of age. Such maximum benefit limit may be exceeded, upon prior approval by the health benefit plan, if the provision of applied behavior analysis services beyond the maximum limit is medically necessary for such individual. Payments made by a health carrier on behalf of a covered individual for any care, treatment, intervention, service or item, the provision of which was for the treatment of a health condition unrelated to the covered individual’s autism spectrum disorder, shall not be applied toward any maximum benefit established under this subsection. Any coverage required under this section, other than the coverage for applied behavior analysis, shall not be subject to the age and dollar limitations described in this subsection.”
114. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 376.1224: Autism spectrum disorders and developmental or physical disabilities, insurance coverage required. Checked October 30, 2026.
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     “6. Coverage for therapeutic care provided under this section for developmental or physical disabilities may be limited to a number of visits per calendar year, provided that upon prior approval by the health benefit plan, coverage shall be provided beyond the maximum calendar limit if such therapeutic care is medically necessary as determined by the health care plan.”
115. Missouri Revisor of Statutes (revisor.mo.gov). RSMo 376.1224: Autism spectrum disorders and developmental or physical disabilities, insurance coverage required. “15. The provisions of this section shall not apply to the Mo HealthNet program as described in chapter 208.” Checked October 30, 2026.
116. Missouri Department of Health and Senior Services. Children & Youth with Special Health Care Needs. Checked October 30, 2026.
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     “The Children and Youth with Special Health Care Needs Program provides two primary services: Service coordination is provided to all participants, regardless of financial status. ... Limited funding for medically necessary diagnostic and treatment services for participants whose families meet financial eligibility guidelines. Funded services may include but are not limited to: Doctor visits, emergency care, inpatient hospitalization, outpatient surgery, prescription medication, diagnostic testing, orthodontia and prosthodontia (cleft lip/palate only), therapy (physical, occupational, speech and respiratory), durable medical equipment, orthotics, hearing aids, specialized formula, and incontinence supplies. Children and Youth with Special Health Needs is payor of last resort.”
117. Missouri Department of Health and Senior Services. Children & Youth with Special Health Care Needs. Checked October 30, 2026.
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     “Be a Missouri resident Be birth to age 21 Have an eligible special health care need (conditions such as Cerebral Palsy, Cystic Fibrosis, Cleft Lip and Palate, Hearing Disorders, Hemophilia, Paraplegia, Quadriplegia, Seizures, Spina Bifida, and Traumatic Brain Injury) Meet financial eligibility guidelines for funded services (family income at or below 185% of the Federal Poverty Guidelines)”
118. Centers for Medicare & Medicaid Services. Who are the MACs: A/B MAC Jurisdiction 5 (J5). “Contract Awardee: Wisconsin Physicians Service Government Health Administrators, contract number 75FCMC19C0043 ... J5 processes FFS Medicare Part A and Part B claims for Iowa, Kansas, Missouri, and Nebraska ...” Checked October 30, 2026.
119. the Missouri Physical Therapy Association (MPTA). the Missouri Physical Therapy Association (MPTA) (the state association's site). Checked October 30, 2026.
120. the Missouri Occupational Therapy Association (MOTA). the Missouri Occupational Therapy Association (MOTA) (the state association's site). Checked October 30, 2026.
121. the Missouri Speech-Language-Hearing Association (MSHA). the Missouri Speech-Language-Hearing Association (MSHA) (the state association's site). Checked October 30, 2026.
122. DrSensory. Occupational therapy clinics in Missouri, 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.
123. 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 Missouri, not legal, compliance, billing or financial advice. Rules change; the clinic confirms each with its source before acting on it.