Texas therapy practice guide: PT, OT and SLP

For OT, PT and SLP clinics in Texas: two boards and a department license the disciplines, a qualified physical therapist may treat without a referral for up to 30 consecutive calendar days, Texas Medicaid covers children’s therapy under EPSDT and adults within its own rules, and telehealth follows the patient’s location. Every rule here is quoted from its source.⁠^1,2,3,4

Who licenses OTs, PTs and SLPs in Texas?

Two boards and a department license the three disciplines in Texas, and each publishes its own licensing law, rules, renewal cycle and continuing-education requirement.⁠^1,5,6 A clinic that employs more than one discipline keeps three registers, not one.

Physical therapists and physical therapist assistants answer to the Texas Board of Physical Therapy Examiners.⁠^1,23,24,25 Occupational therapists and occupational therapy assistants answer to the Texas Board of Occupational Therapy Examiners.⁠^{5,26,27,28,29} Speech-language pathologists answer to the Texas Department of Licensing and Regulation.⁠^{6,30,31,32,33} 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 Texas license renewal require?

Each regulator 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.⁠^1,5,6 A renewal missed is a lapse, and the regulator’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 Texas 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, any physical therapist may evaluate without a referral, and a physical therapist licensed at least one year, carrying the professional liability insurance the board requires and holding a doctoral degree in physical therapy or 30 hours of continuing competence in differential diagnosis may treat a patient without a referral for not more than 30 consecutive calendar days, after the patient signs the board’s disclosure form, and needs a referral from a referring practitioner to continue.⁠^2,7,8 For occupational therapy, an occupational therapist may evaluate a person and provide consultation and monitored services without a referral, but direct occupational therapy for a specific health care condition must be based on a referral from a physician, dentist, chiropractor, podiatrist or another licensed professional authorized to refer, and the board’s rules let a non-medical condition be evaluated and treated without one.⁠^34,35,36 For speech-language pathology, the licensing chapter defines speech-language pathology and requires a license to practice it, and carries no provision that conditions an evaluation or treatment on a physician’s referral.⁠^37,38 Texas Medicaid, as a payer, requires a signed and dated prescribing provider’s order for a therapy evaluation and a separate treatment order for therapy after it.⁠⁸

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.⁠¹⁵ Texas 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 Texas Medicaid pay for pediatric and adult therapy?

Texas Medicaid is run by the Texas Health and Human Services Commission, and a clinic enrolls through its provider enrollment route before it bills.⁠³⁹ 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.⁠⁴⁰ For clients from birth through 20 years of age, Texas Medicaid covers physical, occupational and speech therapy, chronic therapy and treatment of developmental delay included when a medical need is established, under its Comprehensive Care Program, the Texas expansion of EPSDT, known in Texas as Texas Health Steps. Eligible children may continue to receive all medically necessary therapy with documentation proving medical necessity.⁠^3,4

For clients 21 and older, Texas Medicaid covers medically necessary short-term physical, occupational and speech therapy for an acute condition or an acute exacerbation of a chronic condition, up to 120 days per condition or until maximum benefit is reached, whichever comes first. It covers physical and occupational therapy in office, outpatient and home settings, and speech therapy in office and outpatient settings only.⁠⁹ Initial evaluations need no prior authorization, but every therapy service after the evaluation does, requested on the Texas Medicaid PT, OT, ST Prior Authorization Form within five business days of the start of treatment. Acute therapy is authorized in periods of up to 60 days and chronic therapy in periods of up to 180 days.⁠^41,42 Texas Medicaid managed care is run by MCOs under contract with the Health and Human Services Commission in 13 service areas, through the STAR, STAR Kids, STAR+PLUS and STAR Health programs, and the MCOs provide most of the benefits fee-for-service Texas Medicaid provides. Managed care providers enroll with an MCO under contract with Texas Medicaid.⁠^43,44 The fee schedule is published by the agency, and a clinic reads the current file rather than a remembered rate.⁠⁴⁵

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

Texas Medicaid bills therapy with CPT procedure codes, and its initial evaluation codes (92521 to 92524, 92610, 97161 to 97163 and 97165 to 97167) need no prior authorization. Every claim except an evaluation or re-evaluation carries GP, GO or GN, acute therapy adds AT, treatment by an assistant carries UB and by a licensed therapist U5, and timed codes are billed in 15-minute units, with leftover minutes counted as a unit when more than seven. Evaluations are payable once every three years to the same rendering provider, and a licensed therapy assistant cannot enroll as a billing provider.⁠^{46,47,48,49,50} 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 Texas Medicaid pay for therapy in schools?

School Health and Related Services (SHARS) reimburses Texas independent school districts and public charter schools, enrolled as SHARS providers, for direct medical services in a student’s IEP for Medicaid-enrolled students 20 or younger. During school hours, only school districts may deliver therapy to a student on school premises.⁠^51,52 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 Texas Medicaid cover therapy by telehealth?

Texas Medicaid covers listed physical, occupational and speech therapy evaluation and treatment codes by synchronous audiovisual technology when clinically appropriate, safe and agreed to by the patient or legally authorized representative, billed with modifier 95.⁠⁵³ The telehealth section below covers the state’s own rules for the session itself.

What are Texas’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.⁠¹⁰ Occupations Code chapter 111 defines a telehealth service as one delivered by a health professional licensed, certified or otherwise entitled to practice in Texas, holds that professional to the in-person standard of care, and requires the informed consent of the patient or an authorized decision-maker before telehealth services are provided. The physical therapy board’s rule also requires a Texas license or PT Compact privilege and documented written or verbal consent to treatment, data collection and data sharing.⁠^54,55,56

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.⁠^11,12 Insurance Code section 1455.004 requires a health benefit plan to cover a covered service delivered by a preferred or contracted health professional as a telehealth service on the same basis and to the same extent as in person, bars cost sharing above the in-person amount, and does not require coverage of a service delivered only by audio, text-only email or fax.⁠⁵⁷

Which business steps are specific to Texas?

The entity is registered with the Texas Secretary of State, and the choice of entity is shaped by the state’s rule on who may own a therapy business.⁠¹⁹ The Business Organizations Code lets licensed professionals form a professional corporation or professional limited liability company to provide a service that requires a Texas license. Only a professional individual, licensed in Texas or another jurisdiction to provide the same service, or a professional organization may own one, and its officers must be professional individuals.⁠²⁰ State tax registration is with the Texas Workforce Commission, for an employer.⁠⁵⁸ Texas taxes the sale of goods and only the services Tax Code section 151.0101 lists, sixteen categories such as amusement, personal, repair, information, data processing and security services, none of them health care or therapy. Section 151.313 exempts certain health care items, including a brace or orthopedic device and a therapeutic appliance or device dispensed or prescribed by a licensed practitioner of the healing arts for the individual who uses it, and a clinic that sells taxable goods in Texas registers for a sales tax permit.⁠^59,60,61 Texas does not require a private employer to carry workers’ compensation: except for public employers and as otherwise provided by law, an employer may elect to obtain coverage, and an employer that does not must notify the Division of Workers’ Compensation in writing and tell each employee, at hiring and by a posted notice, whether it has coverage.⁠⁶² 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 Texas?

The Texas Department of Licensing and Regulation’s rule requires speech-language pathologists to keep records at least five consecutive years, and Texas Medicaid requires its enrolled providers to keep records at least five years from the date of service or until every audit question, appeal, investigation or court case is resolved. The Texas Board of Physical Therapy Examiners states that the Physical Therapy Practice Act gives it no specific authority to address record retention.⁠^16,17,18 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.⁠^63,64

Health and Safety Code chapter 181, Medical Records Privacy, requires a covered entity to train employees on state and federal privacy law within 90 days of hire and to obtain a separate authorization for each electronic disclosure outside the exceptions it lists, such as disclosures to another covered entity for treatment, payment or health care operations.⁠⁶⁵ Business and Commerce Code section 521.053 requires a person doing business in Texas that owns or licenses computerized sensitive personal information to notify affected individuals without unreasonable delay and within 60 days after determining a breach occurred, and to notify the attorney general within 30 days when the breach involves at least 250 Texas residents.⁠⁶⁶ Family Code section 261.101 makes every individual licensed by the state who has direct contact with children in the normal course of licensed duties a professional reporter, who must personally report suspected child abuse or neglect within 24 hours and may not delegate the report.⁠⁶⁷

Which Texas rules shape a pediatric clinic?

Early Childhood Intervention (ECI) is the Health and Human Services Commission’s statewide program for families of children from birth to 36 months with developmental delays, disabilities or certain medical diagnoses. A referral may rest on professional judgment or a family’s concern, needs no diagnosis or confirmed delay, and goes to the local ECI program for the family’s ZIP code.⁠^21,22 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. Insurance Code section 1355.015 requires a health benefit plan to cover autism screening at 18 and 24 months and, for an enrollee diagnosed before the 10th birthday, all generally recognized services the primary care physician prescribes in the treatment plan, which may include speech, occupational and physical therapy. For an enrollee 10 or older, the plan need not cover applied behavior analysis beyond $36,000 a year.⁠⁶⁸ The autism insurance mandates guide covers how such a mandate meets a plan’s own terms. The Children with Special Health Care Needs (CSHCN) Services Program serves Texans 20 and younger with special health care needs, and people of any age with cystic fibrosis, at or below 200 percent of the federal poverty level, whose medical condition is expected to last at least a year and has physical symptoms. Its provider manual covers physical, occupational and speech therapy for acute or chronic medical conditions when the prescribing physician’s and treating therapist’s documentation shows progress toward goals.⁠^69,70,71

Which Texas rules shape an adult clinic?

Medicare claims from Texas go to Novitas Solutions, Inc., the Medicare Administrative Contractor for Jurisdiction H, Parts A and B (Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma and Texas), whose local coverage articles for therapy are the ones a Texas clinic reads.⁠⁷² Texas Medicaid’s adult therapy rules are in the Medicaid section above. The Division of Workers’ Compensation’s Medical Fee Guideline for Professional Services sets the maximum allowable reimbursement for professional medical services outside a workers’ compensation network by applying Medicare payment policies with minimal modifications and the division’s conversion factor for service categories that include Physical Medicine and Rehabilitation, adjusted each January by the Medicare Economic Index.⁠^73,74

Which associations and directory pages serve Texas?

The state chapters are the Texas Physical Therapy Association for physical therapy, the Texas Occupational Therapy Association for occupational therapy and the Texas Speech-Language-Hearing Association for speech-language pathology.⁠^75,76,77 On DrSensory, families browse Texas 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.⁠⁷⁸

Which Texas cities have DrSensory city pages?

Beyond its three Texas pages, the directory publishes city pages for 19 Texas cities, 52 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.⁠⁷⁸

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

DrSensory lists 344 PT, OT and SLP clinics in Texas, on its occupational therapy, physical therapy and speech therapy pages for the state.⁠⁷⁸

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

Which templates does a Texas launch need?

How might two Texas clinics plan a launch?

Sources

1. Texas. Texas Board of Physical Therapy Examiners. Checked October 30, 2026.
2. Texas Legislative Council (Texas Constitution and Statutes). Occupations Code section 453.301 (as amended by H.B. 4099, effective September 1, 2025). Checked October 30, 2026.
   Show the passageHide the passage

   “A physical therapist may treat a patient for an injury or condition in a manner described by Section 453.005 without a referral if the physical therapist: (1) has been licensed to practice physical therapy for at least one year; (2) is covered by professional liability insurance in the minimum amount required by board rule; and (3) either: (A) possesses a doctoral degree in physical therapy from: ... (B) has completed at least 30 hours of continuing competence activities in the area of differential diagnosis. (a-1) A physical therapist may treat a patient under Subsection (a) for not more than 30 consecutive calendar days. ... (b) The physical therapist must obtain a referral from a referring practitioner before the physical therapist may continue treatment that exceeds treatment authorized under Subsection (a-1).”
3. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook (October 2026), subsection 5.1.2. Checked October 30, 2026.
   Show the passageHide the passage

   “Chronic physical, occupational, and speech therapy services are benefits of Texas Medicaid for the medically necessary treatment of chronic medical conditions and developmental delay when a medical need is established for the developmental delay as indicated in this handbook. All eligible clients who are birth through 20 years of age may continue to receive all medically necessary therapy services, with documentation proving medical necessity.”
4. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. Texas Medicaid Provider Procedures Manual, Children’s Services Handbook (October 2026), subsection 2.1, CCP Overview. Checked October 30, 2026.
   Show the passageHide the passage

   “CCP is an expansion of the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) service as mandated by the Omnibus Budget Reconciliation Act (OBRA) of 1989, which requires all states to provide all medically necessary treatment for correction of physical or mental problems to Texas Health Steps (THSteps)-eligible clients when federal financial participation (FFP) is available, even if the services are not covered under the state’s Medicaid plan.”
5. Texas. Texas Board of Occupational Therapy Examiners. Checked October 30, 2026.
6. Texas. Texas Department of Licensing and Regulation, Speech-Language Pathologists and Audiologists. Checked October 30, 2026.
7. Texas Board of Physical Therapy Examiners. Texas Board of Physical Therapy Examiners Rules (May 2026), 22 TAC section 322.1(a)(2), Exceptions to referral requirement. Checked October 30, 2026.
   Show the passageHide the passage

   “(A) A PT may evaluate without referral. ... (D) A PT may treat a patient for an injury or condition without a referral for not more than 30 consecutive calendar days if the PT: ... (F) A PT who treats a patient without a referral under subparagraph (D) of this paragraph must obtain a signed disclosure on a form prescribed by the board prior to the initiation of treatment.”
8. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook (October 2026), subsections 5.2.1 and 5.2.3. Checked October 30, 2026.
   Show the passageHide the passage

   “Initial evaluations do not require prior authorization (procedure codes 92521, 92522, 92523, 92524, 92610, 97161, 97162, 97163, 97165, 97166, and 97167); however, documentation kept in the client’s record must include a signed and dated prescribing provider’s order for the evaluation, support a medical need for the therapy evaluation, and be available when requested. ... A prescribing provider’s order to evaluate and treat is acceptable for the evaluation or re-evaluation, but is not acceptable for the therapy treatment.”
9. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook (October 2026), subsection 6.1. Checked October 30, 2026.
   Show the passageHide the passage

   “Physical therapy (PT), occupational therapy (OT), and speech therapy (ST) services are benefits of Texas Medicaid for the medically necessary short term treatment of an acute medical condition or an acute exacerbation of a chronic medical condition for clients who are 21 years of age and older. ... Adult therapy services are limited to a maximum of 120 days per identified acute medical condition or acute exacerbation of a chronic medical condition requiring therapy or whenever the maximum benefit from therapy has been achieved, whichever comes first. ... Physical and occupational therapy services for acute conditions are benefits of Texas Medicaid for adult clients in the office, outpatient, and home settings. Speech therapy services for acute conditions are benefits of Texas Medicaid for adult clients in the office and outpatient setting only.”
10. U.S. Department of Health and Human Services. Getting started with licensure (Telehealth.HHS.gov, last updated February 21, 2024). Checked October 26, 2026.
    Show the passageHide the passage

    “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”.
11. PT Compact Commission. PT Compact Map. “Member States (38) ... Texas ... Compact Privilege Availability 38 Member States Actively Issuing and Accepting Compact Privileges ...” Checked October 30, 2026.
12. Executive Council of Physical Therapy and Occupational Therapy Examiners. Compact. Checked October 30, 2026.
    Show the passageHide the passage

    “Texas joined the PT Compact with the enactment of the enabling statutes in Senate Bill 317 that was signed into law by Governor Greg Abbott on June 9, 2017. ... Compact privileges for Texas licensees to practice in another member state and for licensees of other member states to be able to practice in Texas became available January 02, 2019.”
13. Occupational Therapy Compact Commission. State Commissioners. Checked October 30, 2026.
14. Audiology and Speech-Language Pathology Interstate Compact Commission. Delegate Information. Checked October 30, 2026.
15. 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.
    Show the passageHide the passage

    “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.”.
16. Texas Secretary of State (Texas Administrative Code). 16 TAC section 111.153, Recordkeeping and Billing. Checked October 30, 2026.
    Show the passageHide the passage

    “(a) A licensee shall maintain accurate records of professional services rendered. (b) Records must be maintained for a minimum of five consecutive years or longer as warranted. (c) Records are the responsibility and property of the entity or individual who owns the practice or the practice setting. (d) Records created as a result of treatment in a school setting shall be maintained as part of the student’s permanent school record.”
17. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. Texas Medicaid Provider Procedures Manual, Section 1: Provider Enrollment and Responsibilities (October 2026), subsection 1.7.4. Checked October 30, 2026.
    Show the passageHide the passage

    “These documents and claims must be retained for a minimum period of five years from the date of service or until all audit questions, appeal hearings, investigations, or court cases are resolved.”
18. Executive Council of Physical Therapy and Occupational Therapy Examiners. PT Practice FAQs: Medical Records & Reimbursement. “How long must I keep medical records? The Physical Therapy Practice Act does not give the Board specific authority to address record retention.” Checked October 30, 2026.
19. Texas Secretary of State. SOSDirect. Checked October 30, 2026.
20. Texas Legislative Council (Texas Constitution and Statutes). Business Organizations Code sections 301.003, 301.004 and 301.007. Checked October 30, 2026.
    Show the passageHide the passage

    “"Professional individual," with respect to a professional entity, means an individual who is licensed to provide in this state or another jurisdiction the same professional service as is rendered by that professional entity. (6) "Professional limited liability company" means a limited liability company formed for the purpose of providing a professional service and governed as a professional entity under this title. ... "Professional service" means any type of service that requires, as a condition precedent to the rendering of the service, the obtaining of a license in this state ... For purposes of this title, a person is an authorized person with respect to: (1) a professional association if the person is a professional individual; and (2) a professional corporation or a professional limited liability company if the person is a professional individual or professional organization. ... A person may be an owner of a professional entity or a governing person of a professional limited liability company only if the person is an authorized person. (b) An individual may be an officer of a professional entity or a governing person of a professional association or professional corporation only if the individual is a professional individual.”
21. Texas Health and Human Services Commission. Early Childhood Intervention Services. Checked October 30, 2026.
    Show the passageHide the passage

    “Early Childhood Intervention (ECI) is a statewide program within the Texas Health and Human Services Commission for families with children from birth to 36 months with developmental delays, disabilities or certain medical diagnoses that may impact development. ECI services support families as they learn how to help their children grow and learn.”
22. Texas Health and Human Services Commission. Make a Referral to ECI. Checked October 30, 2026.
    Show the passageHide the passage

    “A referral to ECI can be based on professional judgment or a family’s concern. A medical diagnosis or a confirmed developmental delay is not needed to refer. As soon as a delay is suspected, children may be referred to ECI, even as early as birth. To refer a child, up to 36 months of age, please contact the ECI program in your area. ECI contracts with different organizations to provide ECI services throughout Texas. Some urban areas with large populations have several ECI programs. Each ECI program provides services to families living in specific areas identified by ZIP code. ... Call the HHS Office of the Ombudsman at 1-877-787-8999, select a language, and then select Option 3.”
23. Texas Board of Physical Therapy Examiners. Texas Board of Physical Therapy Examiners Rules (May 2026), 22 TAC section 341.1, Requirements for Renewal. “Biennial renewal. Licensees are required to renew their licenses every two years by the end of their birth month.” Checked October 30, 2026.
24. Texas Board of Physical Therapy Examiners. Texas Board of Physical Therapy Examiners Rules (May 2026), 22 TAC section 341.2, Continuing Competence Requirements. Checked October 30, 2026.
    Show the passageHide the passage

    “For each biennial renewal, physical therapists must complete a total of 30 continuing competence units (CCUs); physical therapist assistants must complete a total of 20 CCUs. ... All licensees must complete a board-approved jurisprudence assessment module as part of their total continuing competence requirement.”
25. Texas Board of Physical Therapy Examiners. Texas Board of Physical Therapy Examiners Rules (May 2026), 22 TAC section 322.3, Supervision. Checked October 30, 2026.
    Show the passageHide the passage

    “It is the responsibility of each PT and/or PTA to determine the number of PTAs and/or aides he or she can supervise safely. (b) Supervision of PTAs. (1) A supervising PT is responsible for and will participate in the patient’s care. (2) A supervising PT must be on call and readily available when physical therapy services are being provided. ... (4) The supervising PT must hold documented conferences with the PTA regarding the patient. The PT is responsible for determining the frequency of the conferences consistent with accepted standards of practice.”
26. Texas Board of Occupational Therapy Examiners. Occupational Therapy Rules (June 2026), 40 TAC section 370.1, License Renewal. “Licensees are required to renew their licenses every two years by the end of their birth month. A licensee may not provide occupational therapy services without a current license.” Checked October 30, 2026.
27. Texas Board of Occupational Therapy Examiners. Occupational Therapy Rules (June 2026), 40 TAC section 367.1, Continuing Education. Checked October 30, 2026.
    Show the passageHide the passage

    “All licensees must complete a minimum of 24 contact hours every two years during the period of time the license is current in order to renew the license. ... As part of the minimum hours of required continuing education for each renewal, licensees must complete a training course on human trafficking that is approved by the Texas Health and Human Services Commission.”
28. Texas Board of Occupational Therapy Examiners. Occupational Therapy Rules (June 2026), 40 TAC section 372.1(f) and (g), Provision of Services. Checked October 30, 2026.
    Show the passageHide the passage

    “Only an occupational therapist may initiate, develop, modify, or complete an occupational therapy plan of care. ... Except where otherwise restricted by rule, the supervising occupational therapist may only delegate to an occupational therapy assistant tasks that they both agree are within the competency level of that occupational therapy assistant. ... In each intervention note, the occupational therapy assistant must include the name of an occupational therapist who is readily available to answer questions about the client’s intervention at the time of the provision of services. The occupational therapist in the intervention note may be different from the occupational therapist who wrote the plan of care. The occupational therapy assistant may not provide services unless this requirement is met.”
29. Texas Legislative Council (Texas Constitution and Statutes). Occupations Code section 454.002(6). “"Occupational therapy assistant" means a person licensed by the board as an occupational therapy assistant who assists in the practice of occupational therapy under the general supervision of an occupational therapist.” Checked October 30, 2026.
30. Texas Department of Licensing and Regulation. Renew Your Speech-Language Pathology or Audiology License. “All licenses are issued licenses for 2 years, except for Intern licenses, which are valid for one year.” Checked October 30, 2026.
31. Texas Department of Licensing and Regulation. Speech-Language Pathology and Audiology Continuing Education. Checked October 30, 2026.
    Show the passageHide the passage

    “To renew and maintain continuous licensure, you must complete all continuing education requirements prior to the expiration of your license. ... Speech-language pathologists are required to obtain 20 clock hours of continuing education (2 continuing education units), with 2 clock hours (0.2 continuing education units) in ethics. ... An assistant in speech-language pathology is required to obtain 20 clock hours of continuing education (2 continuing education units), with 2 clock hours (0.2 continuing education units) in ethics.”
32. Texas Secretary of State (Texas Administrative Code). 16 TAC section 111.51, Assistant in Speech-Language Pathology License--Supervision Requirements. Checked October 30, 2026.
    Show the passageHide the passage

    “A licensed assistant in speech-language pathology (assistant) must be supervised by a licensed speech-language pathologist who has been approved by the department to serve as the assistant’s supervisor (supervisor). ... Initial contacts directly with the client must be conducted by the supervisor. ... Each supervisor must provide a minimum of eight hours per calendar month of supervision to the assistant. This subsection applies whether the assistant is employed full-time or part-time. (1) At least four hours must be direct supervision. (2) The remaining hours may be performed using indirect supervision. ... (4) Tele-supervision may be used for direct and indirect supervision.”
33. Texas Secretary of State (Texas Administrative Code). 16 TAC section 111.154, Supervision Requirements and Responsibilities. Checked October 30, 2026.
    Show the passageHide the passage

    “A licensee must have at least two years of professional experience in providing direct client services in the area of licensure in order to supervise an intern or assistant. ... supervise no more than a total of four speech-language pathology interns and/or assistants ...”
34. Texas Legislative Council (Texas Constitution and Statutes). Occupations Code section 454.213. Checked October 30, 2026.
    Show the passageHide the passage

    “(a) An occupational therapist may enter a case to: (1) provide consultation and monitored services; or (2) evaluate a person for the need for services. (b) Implementation of direct occupational therapy to a person for a specific health care condition must be based on a referral from: (1) a physician licensed by a state board of medical examiners; (2) a dentist licensed by a state board of dental examiners; (3) a chiropractor licensed by a state board of chiropractic examiners; (4) a podiatrist licensed by a state board of podiatric medical examiners; or (5) another qualified, licensed health care professional who is authorized to refer for health care services within the scope of the professional’s license.”
35. Texas Board of Occupational Therapy Examiners. Occupational Therapy Rules (June 2026), 40 TAC section 372.1(a) and (b), Provision of Services. Checked October 30, 2026.
    Show the passageHide the passage

    “(2) Intervention for a medical condition by an occupational therapy practitioner requires a referral from a licensed referral source. (b) Non-Medical Conditions. The evaluation or intervention for a non-medical condition does not require a referral. However, a referral must be requested at any time during the evaluation or intervention process when necessary to ensure the safety and welfare of the client.”
36. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook (October 2026), subsections 5.2.1 and 5.2.3. Checked October 30, 2026.
    Show the passageHide the passage

    “Initial evaluations do not require prior authorization (procedure codes 92521, 92522, 92523, 92524, 92610, 97161, 97162, 97163, 97165, 97166, and 97167); however, documentation kept in the client’s record must include a signed and dated prescribing provider’s order for the evaluation, support a medical need for the therapy evaluation, and be available when requested. ... A prescribing provider’s order to evaluate and treat is acceptable for the evaluation or re-evaluation, but is not acceptable for the therapy treatment.”
37. Texas Legislative Council (Texas Constitution and Statutes). Occupations Code sections 401.001(6) and 401.301. Checked October 30, 2026.
    Show the passageHide the passage

    “"Speech-language pathology" means the application of nonmedical principles, methods, and procedures for measurement, testing, evaluation, prediction, counseling, habilitation, rehabilitation, or instruction related to the development and disorders of communication, including speech, voice, language, oral pharyngeal function, or cognitive processes, for the purpose of evaluating, preventing, or modifying or offering to evaluate, prevent, or modify those disorders and conditions in an individual or a group. ... A person may not practice speech-language pathology or audiology or represent that the person is a speech-language pathologist or audiologist in this state unless the person holds a license under this chapter.”
38. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook (October 2026), subsections 5.2.1 and 5.2.3. Checked October 30, 2026.
    Show the passageHide the passage

    “Initial evaluations do not require prior authorization (procedure codes 92521, 92522, 92523, 92524, 92610, 97161, 97162, 97163, 97165, 97166, and 97167); however, documentation kept in the client’s record must include a signed and dated prescribing provider’s order for the evaluation, support a medical need for the therapy evaluation, and be available when requested. ... A prescribing provider’s order to evaluate and treat is acceptable for the evaluation or re-evaluation, but is not acceptable for the therapy treatment.”
39. Texas Medicaid & Healthcare Partnership. Provider Enrollment. Checked October 30, 2026.
40. Medicaid.gov (Centers for Medicare & Medicaid Services). Early and Periodic Screening, Diagnostic, and Treatment (Medicaid benefit page). Checked October 26, 2026.
    Show the passageHide the passage

    “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.”.
41. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook (October 2026), subsections 5.2.1 and 5.2.1.1. Checked October 30, 2026.
    Show the passageHide the passage

    “Therapy services, regardless of place or provider, occurring after the initial evaluation, require prior authorization. ... For acute therapy services, i.e. acute services billed with an AT modifier, prior authorization requests may not exceed a 60 day period per each request. After two 60 day authorized periods, any continued requests for therapy services must be considered under the chronic sections of this handbook. For chronic therapy services, prior authorization may be granted for up to 180 days with documentation of medical necessity and additional prior authorizations. Initial prior authorization (PA) requests must be received no later than five business days from the date therapy treatments are initiated.”
42. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook (October 2026), subsection 5.2. Checked October 30, 2026.
    Show the passageHide the passage

    “Providers must list all relevant procedure codes on the Texas Medicaid Physical, Occupational, or Speech Therapy (PT, OT, ST) Prior Authorization Form when requesting prior authorization for therapy services.”
43. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. Texas Medicaid Provider Procedures Manual, Medicaid Managed Care Handbook (October 2026), section 2. Checked October 30, 2026.
    Show the passageHide the passage

    “The information in this handbook is intended for Texas Medicaid managed care providers, including providers who are enrolled in a managed care organization (MCO) that is contracted by Texas Medicaid to provide managed care coverage for Texas Medicaid clients. ... Medicaid managed care is administered by MCOs and dental maintenance organizations (DMOs) that are contracted by HHSC to provide services for Medicaid managed care clients. The Medicaid managed care MCOs and DMOs provide most of the same benefits that Texas Medicaid provides for Medicaid fee-for-service clients. ... Medicaid managed care uses MCOs to cover services in 13 service areas (SAs).”
44. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. Texas Medicaid Provider Procedures Manual, Medicaid Managed Care Handbook (October 2026), section 2. “The STAR program uses MCOs to cover acute care services for children, newborns, pregnant women, and some families.” Checked October 30, 2026.
45. Texas Medicaid & Healthcare Partnership. Fee Schedules (Online Fee Lookup). Checked October 30, 2026.
46. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook (October 2026), subsection 7.2.1. Checked October 30, 2026.
    Show the passageHide the passage

    “Modifiers GP, GO, and GN are required on all claims except when billing evaluation and re-evaluation procedure codes. The AT modifier must be included on claims for acute therapy services.”
47. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook (October 2026), subsections 5.2.1 and 5.5.5. Checked October 30, 2026.
    Show the passageHide the passage

    “Initial evaluations do not require prior authorization (procedure codes 92521, 92522, 92523, 92524, 92610, 97161, 97162, 97163, 97165, 97166, and 97167) ... Procedure codes for PT, OT, and ST evaluations are payable once every three years to the same rendering provider.”
48. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook (October 2026), subsection 6.1 (modifier table). Checked October 30, 2026.
    Show the passageHide the passage

    “UB Services delivered by a licensed therapy assistant under supervision of a licensed therapist U5 Services delivered by a licensed therapist or physician ...”
49. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. Texas Medicaid Provider Procedures Manual, Section 1: Provider Enrollment and Responsibilities (October 2026), subsection 1.7.18. Checked October 30, 2026.
    Show the passageHide the passage

    “Note: Auxiliary (aide, orderly, student, or technician), a licensed therapy assistant, and a licensed speech-language pathology intern (Clinical Fellow) are not eligible to enroll as therapy providers in Texas Medicaid.”
50. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook (October 2026), subsection 7.2.1. Checked October 30, 2026.
    Show the passageHide the passage

    “To calculate billing units, count the total number of billable minutes for the calendar day for the client, and divide by 15 to convert to billable units of service. If the total billable minutes are not divisible by 15, the minutes are converted to one unit of service if they are greater than seven and converted to zero units of service if they are seven or fewer minutes.”
51. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. Texas Medicaid Provider Procedures Manual, School Health and Related Services (SHARS) Handbook (October 2026), subsection 2.1. Checked October 30, 2026.
    Show the passageHide the passage

    “SHARS are direct medical services and transportation services available to children who are 20 years of age or younger, enrolled in Medicaid and are eligible to receive services under the Individuals with Disabilities Education Act (IDEA). The services must be included in the child’s individualized education program (IEP) established under IDEA. ... Local Education Agencies (LEAs), which include Texas independent school districts (ISDs) and public charter schools, must enroll in Texas Medicaid as a SHARS provider to be reimbursed for providing direct medical and transportation services to Medicaid enrolled students in a school setting.”
52. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook (October 2026), subsection 5.1. Checked October 30, 2026.
    Show the passageHide the passage

    “Services provided to a client on school premises are only permitted when delivered before or after school hours. The only PT, OT, and ST services that can be delivered during school hours are therapy services provided by school districts as School Health and Related Services (SHARS).”
53. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook (October 2026), subsection 4.5. Checked October 30, 2026.
    Show the passageHide the passage

    “Evaluation, reevaluation, and treatment of some PT, OT, and ST services may be provided by synchronous audiovisual technology. Telehealth services for OT, PT or ST by synchronous audiovisual technology are allowed for specific procedure codes if clinically appropriate as determined by the practitioner, per standard of care, safe, agreed to by the person receiving services or by the legally authorized representative (LAR), and in compliance with each discipline’s rules. ... Providers must use modifier 95 to indicate remote delivery.”
54. Texas Legislative Council (Texas Constitution and Statutes). Occupations Code sections 111.001(3) and 111.007(a). Checked October 30, 2026.
    Show the passageHide the passage

    “"Telehealth service" means a health service, other than a telemedicine medical service or a teledentistry dental service, delivered by a health professional licensed, certified, or otherwise entitled to practice in this state and acting within the scope of the health professional’s license, certification, or entitlement to a patient at a different physical location than the health professional using telecommunications or information technology. ... A health professional providing a health care service or procedure as a telemedicine medical service, a teledentistry dental service, or a telehealth service is subject to the standard of care that would apply to the provision of the same health care service or procedure in an in-person setting.”
55. Texas Legislative Council (Texas Constitution and Statutes). Occupations Code section 111.002(a). Checked October 30, 2026.
    Show the passageHide the passage

    “A treating physician, dentist, or health professional who provides or facilitates the use of telemedicine medical services, teledentistry dental services, or telehealth services shall ensure that the informed consent of the patient, or another appropriate individual authorized to make health care treatment decisions for the patient, is obtained before telemedicine medical services, teledentistry dental services, or telehealth services are provided.”
56. Texas Board of Physical Therapy Examiners. Texas Board of Physical Therapy Examiners Rules (May 2026), 22 TAC section 322.5, Telehealth. Checked October 30, 2026.
    Show the passageHide the passage

    “Physical therapy telehealth services must be provided by a physical therapist or physical therapist assistant under the supervision of the physical therapist who possesses a current: (1) unrestricted Texas license; or (2) Compact Privilege to practice in Texas. ... A physical therapist that provides telehealth services must obtain and maintain the informed consent of the patient, or of another individual authorized to make health care treatment decisions for the patient, prior to the provision of telehealth services. (1) The informed consent must include the patient’s consent to: (A) treatment; (B) data collection; and (C) data sharing. (2) Consent documentation is acceptable either in written form or verbally.”
57. Texas Legislative Council (Texas Constitution and Statutes). Insurance Code section 1455.004. Checked October 30, 2026.
    Show the passageHide the passage

    “A health benefit plan: (1) must provide coverage for a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service, teledentistry dental service, or telehealth service on the same basis and to the same extent that the plan provides coverage for the service or procedure in an in-person setting ... The amount of the deductible, copayment, or coinsurance may not exceed the amount of the deductible, copayment, or coinsurance required for the covered health care service or procedure provided through an in-person consultation. ... Notwithstanding Subsection (a), a health benefit plan is not required to provide coverage for a telemedicine medical service, a teledentistry dental service, or a telehealth service provided by only synchronous or asynchronous audio interaction, including: (1) an audio-only telephone consultation; (2) a text-only e-mail message; or (3) a facsimile transmission.”
58. Texas Workforce Commission. Unemployment Tax Registration - Register a Tax Account. “Texas Unemployment Compensation Act requires employers to register with the Texas Workforce Commission (TWC) within 10 days of becoming liable.” Checked October 30, 2026.
59. Texas Legislative Council (Texas Constitution and Statutes). Tax Code section 151.0101. Checked October 30, 2026.
    Show the passageHide the passage

    “"Taxable services" means: (1) amusement services; (2) cable television services; (3) personal services; (4) motor vehicle parking and storage services; (5) the repair, remodeling, maintenance, and restoration of tangible personal property, except: ... (6) telecommunications services; (7) credit reporting services; (8) debt collection services; (9) insurance services; (10) information services; (11) real property services; (12) data processing services; (13) real property repair and remodeling; (14) security services; (15) telephone answering services; and (16) a sale by a transmission and distribution utility ...”
60. Texas Legislative Council (Texas Constitution and Statutes). Tax Code section 151.313(a). Checked October 30, 2026.
    Show the passageHide the passage

    “The following items are exempted from the taxes imposed by this chapter: ... (5) a brace; hearing aid or audio loop; orthopedic, dental, or prosthetic device; ileostomy, colostomy, or ileal bladder appliance; or supplies or replacement parts for the listed items; (6) a therapeutic appliance, device, and any related supplies specifically designed for those products, if dispensed or prescribed by a licensed practitioner of the healing arts, when those items are purchased and used by an individual for whom the items listed in this subdivision were dispensed or prescribed ...”
61. Texas Comptroller of Public Accounts. Texas Online Tax Registration Application. “Complete this application if you are engaged in business in Texas; and you sell or lease tangible personal property in Texas; or you sell taxable services in Texas.” Checked October 30, 2026.
62. Texas Legislative Council (Texas Constitution and Statutes). Labor Code sections 406.002, 406.004 and 406.005. Checked October 30, 2026.
    Show the passageHide the passage

    “Except for public employers and as otherwise provided by law, an employer may elect to obtain workers’ compensation insurance coverage. ... An employer who does not obtain workers’ compensation insurance coverage shall notify the division in writing, in the time and as prescribed by commissioner rule, that the employer elects not to obtain coverage. ... An employer shall notify each employee as provided by this section whether or not the employer has workers’ compensation insurance coverage. (b) The employer shall notify a new employee of the existence or absence of workers’ compensation insurance coverage at the time the employee is hired. (c) Each employer shall post a notice of whether the employer has workers’ compensation insurance coverage at conspicuous locations at the employer’s place of business as necessary to provide reasonable notice to the employees.”
63. 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.
    Show the passageHide the passage

    “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.”.
64. 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.
    Show the passageHide the passage

    “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.”.
65. Texas Legislative Council (Texas Constitution and Statutes). Health and Safety Code sections 181.101 and 181.154 (Chapter 181, Medical Records Privacy). Checked October 30, 2026.
    Show the passageHide the passage

    “Each covered entity shall provide training to employees of the covered entity regarding the state and federal law concerning protected health information as necessary and appropriate for the employees to carry out the employees’ duties for the covered entity. (b) An employee of a covered entity must complete training described by Subsection (a) not later than the 90th day after the date the employee is hired by the covered entity. ... Except as provided by Subsection (c), a covered entity may not electronically disclose an individual’s protected health information to any person without a separate authorization from the individual or the individual’s legally authorized representative for each disclosure. ... (c) The authorization for electronic disclosure of protected health information described by Subsection (b) is not required if the disclosure is made: (1) to another covered entity, as that term is defined by Section 181.001, or to a covered entity, as that term is defined by Section 602.001, Insurance Code, for the purpose of: (A) treatment; (B) payment; (C) health care operations; ...”
66. Texas Legislative Council (Texas Constitution and Statutes). Business and Commerce Code section 521.053. Checked October 30, 2026.
    Show the passageHide the passage

    “A person who conducts business in this state and owns or licenses computerized data that includes sensitive personal information shall disclose any breach of system security, after discovering or receiving notification of the breach, to any individual whose sensitive personal information was, or is reasonably believed to have been, acquired by an unauthorized person. The disclosure shall be made without unreasonable delay and in each case not later than the 60th day after the date on which the person determines that the breach occurred ... A person who is required to disclose or provide notification of a breach of system security under this section shall notify the attorney general of that breach as soon as practicable and not later than the 30th day after the date on which the person determines that the breach occurred if the breach involves at least 250 residents of this state.”
67. Texas Legislative Council (Texas Constitution and Statutes). Family Code section 261.101(b). Checked October 30, 2026.
    Show the passageHide the passage

    “If a professional has reasonable cause to believe that a child has been abused or neglected or may be abused or neglected ... the professional shall make a report not later than the 24th hour after the hour the professional first has reasonable cause to believe that the child has been or may be abused or neglected or is a victim of an offense under Section 21.11, Penal Code. A professional may not delegate to or rely on another person to make the report. In this subsection, "professional" means an individual who is licensed or certified by the state or who is an employee of a facility licensed, certified, or operated by the state and who, in the normal course of official duties or duties for which a license or certification is required, has direct contact with children.”
68. Texas Legislative Council (Texas Constitution and Statutes). Insurance Code section 1355.015. Checked October 30, 2026.
    Show the passageHide the passage

    “(a) At a minimum, a health benefit plan must provide coverage for screening a child for autism spectrum disorder at the ages of 18 and 24 months. (a-1) At a minimum, a health benefit plan must provide coverage for treatment of autism spectrum disorder as provided by this section to an enrollee who is diagnosed with autism spectrum disorder from the date of diagnosis, only if the diagnosis was in place prior to the child’s 10th birthday. (b) The health benefit plan must provide coverage under this section to the enrollee for all generally recognized services prescribed in relation to autism spectrum disorder by the enrollee’s primary care physician in the treatment plan recommended by that physician. ... (c) For purposes of Subsection (b), "generally recognized services" may include services such as: (1) evaluation and assessment services; (2) applied behavior analysis; (3) behavior training and behavior management; (4) speech therapy; (5) occupational therapy; (6) physical therapy; or (7) medications or nutritional supplements used to address symptoms of autism spectrum disorder. (c-1) The health benefit plan is not required to provide coverage under Subsection (b) for benefits for an enrollee 10 years of age or older for applied behavior analysis in an amount that exceeds $36,000 per year.”
69. Texas Health and Human Services Commission. Children with Special Health Care Needs Services Program. Checked October 30, 2026.
    Show the passageHide the passage

    “The Children with Special Health Care Needs (CSHCN) Services Program helps people 20 and younger who have special health care needs and people with cystic fibrosis of any age improve their health, well-being and quality of life. ... Lives in Texas. Is 20 or younger or any age with a diagnosis of cystic fibrosis. Has an income level at or below 200 percent of the federal poverty level. Has a medical condition that: Is expected to last at least one year. Will limit one or more major life activities. Requires a higher level of health care. Has physical symptoms.”
70. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. CSHCN Services Program Provider Manual (October 2026), Physical Medicine and Rehabilitation, subsection 30.2. Checked October 30, 2026.
    Show the passageHide the passage

    “Physical therapy (PT) and occupational therapy (OT) services are benefits of the CSHCN Services Program for clients with an acute or chronic medical condition when documentation from the prescribing physician and the treating therapist shows there is or will be progress made toward goals.”
71. Texas Medicaid & Healthcare Partnership, for the Texas Health and Human Services Commission. CSHCN Services Program Provider Manual (October 2026), Speech-Language Pathology Services, subsection 37.2. Checked October 30, 2026.
    Show the passageHide the passage

    “SLP services are benefits of the CSHCN Services Program for clients with acute or chronic medical conditions when documentation from the prescribing physician and the treating therapist shows there is or will be progress made towards goals.”
72. Centers for Medicare & Medicaid Services. Who are the MACs: A/B MAC Jurisdiction H (JH). “Contract Awardee: Novitas Solutions, Inc., contract number 75FCMC19C0018 ... JH processes FFS Medicare Part A and Part B claims for Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas ...” Checked October 30, 2026.
73. Texas Secretary of State (Texas Administrative Code). 28 TAC section 134.203, Medical Fee Guideline for Professional Services. Checked October 30, 2026.
    Show the passageHide the passage

    “This section applies to professional medical services provided in the Texas workers’ compensation system, other than: ... To determine the MAR for professional services, system participants shall apply the Medicare payment policies with minimal modifications. (1) For service categories of Evaluation & Management, General Medicine, Physical Medicine and Rehabilitation, Radiology, Pathology, Anesthesia, and Surgery when performed in an office setting ... Subsequent year’s conversion factors shall be determined by applying the annual percentage adjustment of the Medicare Economic Index (MEI) to the previous year’s conversion factors, and shall be effective January 1st of the new calendar year.”
74. Texas Department of Insurance, Division of Workers’ Compensation. Medical and facility fee guidelines and information. “In the Texas workers’ compensation system, reimbursement for most medical services and treatments not provided through a workers’ compensation health care network is determined by the Division of Workers’ Compensation (DWC) fee guidelines.” Checked October 30, 2026.
75. the Texas Physical Therapy Association. the Texas Physical Therapy Association (the state association's site). Checked October 30, 2026.
76. the Texas Occupational Therapy Association. the Texas Occupational Therapy Association (the state association's site). Checked October 30, 2026.
77. the Texas Speech-Language-Hearing Association. the Texas Speech-Language-Hearing Association (the state association's site). Checked October 30, 2026.
78. DrSensory. Occupational therapy clinics in Texas, 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.
79. 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 Texas, not legal, compliance, billing or financial advice. Rules change; the clinic confirms each with its source before acting on it.