Montana Medicaid (Healthcare Programs) pediatric speech and OT coverage: limits, prior authorization and who can bill
The short answerSLP and OT. Montana's therapy manual (last updated March 2020) says therapy needs no prior authorization. Children age 20 and under are not limited to a set number of hours or units if therapy is restorative, not maintenance. An order or referral is needed and lasts 180 days. Assistants and aides bill under the supervising therapist.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · Montana. Public policy, not the member's benefits.
Montana Medicaid (Healthcare Programs)
Physical Therapy, Occupational Therapy, and Speech Therapy Services Manual · Montana
| Where it applies | Covers restorative therapy that is reasonable and necessary and results in improved function. Maintenance therapy may be covered under the HCBS program instead. [1] |
|---|---|
| Visit limits | Under EPSDT, therapy for children is not restricted to a specific number of hours or units as long as the therapy is restorative, not maintenance, and the other requirements are met. [1] |
| Prior authorization | Therapy services do not require prior authorization (Montana therapy services manual, last updated March 2020). [1] |
| Referral | Therapy needs a current written or verbal order or referral from the member's physician or mid-level practitioner. Services given before the order are not covered. An order or referral is valid for 180 days from the day the therapist receives it. [1] |
| Who can bill | A therapy assistant or aide may perform services within their scope but the claim is billed under the supervising licensed therapist's NPI. An assistant or aide may not enroll as a provider. [1] |
| Also | Not covered: therapist time for care meetings, paperwork or reports, observation, and missed or canceled appointments (manual last updated March 2020). [1] |
- Montana DPHHS: Physical Therapy, Occupational Therapy, and Speech Therapy Services Manual, checked October 30, 2026
What Montana Medicaid (Healthcare Programs)'s documents say
The table above has every field we found for Montana Medicaid (Healthcare Programs), with numbered sources. In short:
- Prior authorization. Therapy services do not require prior authorization (Montana therapy services manual, last updated March 2020).
- Visit limits. Under EPSDT, therapy for children is not restricted to a specific number of hours or units as long as the therapy is restorative, not maintenance, and the other requirements are met.
- Who can bill. A therapy assistant or aide may perform services within their scope but the claim is billed under the supervising licensed therapist's NPI. An assistant or aide may not enroll as a provider.
Check Montana Medicaid (Healthcare Programs)'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.