Arizona Medicaid (AHCCCS) pediatric speech and OT coverage: limits, prior authorization and who can bill
The short answerSLP and OT. AHCCCS covers outpatient OT for ALTCS members and members under 21, and outpatient speech therapy for all members based on medical necessity, ordered by the PCP or attending physician (Policy 310-X, effective 10/01/25).
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · Arizona. Public policy, not the member's benefits.
Arizona Medicaid (AHCCCS)
AHCCCS Medical Policy Manual 310-X (effective 10/01/25) · Arizona
| Where it applies | AHCCCS covers occupational, physical and speech therapy ordered by a PCP or attending physician and included in the member's individualized plan. Outpatient OT is covered for ALTCS members and members under age 21. [1] |
|---|---|
| Visit limits | Outpatient speech therapy is covered for all members based on medical necessity. Acute members age 21 and older get 15 OT visits per benefit year to restore a skill and 15 more to acquire a new skill. [1] |
| Prior authorization | The manual refers fee-for-service providers to AMPM Policy 820 for prior authorization requirements. [1] |
| Referral | Services must be ordered by the PCP or attending physician and included in the member's individualized plan, which the PCP, attending physician or a nonphysician practitioner reviews at least every 62 days. [1] |
| Who can bill | The SLP must be identified as the treating AHCCCS registered provider and bill under their individual NPI number; a group ID number is used to direct payment. [1] |
What Arizona Medicaid (AHCCCS)'s documents say
The table above has every field we found for Arizona Medicaid (AHCCCS), with numbered sources. In short:
- Prior authorization. The manual refers fee-for-service providers to AMPM Policy 820 for prior authorization requirements.
- Visit limits. Outpatient speech therapy is covered for all members based on medical necessity. Acute members age 21 and older get 15 OT visits per benefit year to restore a skill and 15 more to acquire a new skill.
- Who can bill. The SLP must be identified as the treating AHCCCS registered provider and bill under their individual NPI number; a group ID number is used to direct payment.
Check Arizona Medicaid (AHCCCS)'s claim against the row
Before the claim goes out, compare it with the row above: the evaluation and treatment codes are ones the policy lists, the plan of care and any prior authorization cover the date, and the visit count fits the limit. The pediatric speech and OT table compares Medicaid with every other payer we checked.