Ohio Medicaid (fee-for-service) pediatric speech and OT coverage: limits, prior authorization and who can bill
The short answerSLP and OT. Ohio Medicaid pays skilled therapy, including developmental services for children under 7, up to 30 visits per discipline per benefit year without prior authorization. OT needs a prescription and speech therapy a referral.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · Ohio. Public policy, not the member's benefits.
Ohio Medicaid (fee-for-service)
OAC 5160-8-35 Skilled therapy services · Ohio
| Where it applies | Ohio defines developmental service as skilled therapy that enables individuals younger than seven years of age to attain a level of age-appropriate functionality they have not yet achieved but are expected to achieve. Skilled therapy includes occupational therapy and speech-language pathology. [1] |
|---|---|
| Visit limits | Without prior authorization in a non-institutional setting, payment is limited to 30 visits per benefit year each for physical therapy, occupational therapy, and speech-language pathology and audiology. An evaluation is paid not more than once per injury or condition for each type of skilled therapy. [1] |
| Prior authorization | Payment for additional skilled therapy visits in a non-institutional setting can be requested through the prior authorization process in rule 5160-1-31. [1] |
| Referral | The service must follow a prescription for physical or occupational therapy, or a referral for speech-language pathology and audiology, from a licensed practitioner of the healing arts. This does not apply to Medicaid school program services. [1] |
| Who can bill | A skilled therapist (including an occupational therapist or speech-language pathologist) may render and bill for services. A hospital, physician, advanced practice registered nurse, physician assistant, podiatrist, professional medical group, ambulatory health care clinic or FQHC or RHC may bill on behalf of a rendering provider. [1] |
| Payment | Payment is the lesser of the submitted charge or a percentage of the fee schedule amount: 100 percent for the first unit of the primary procedure and 80 percent for each additional unit or procedure within the same therapy discipline. [1] |
- Ohio Administrative Code Rule 5160-8-35, Skilled therapy services (effective January 1, 2024), checked October 30, 2026
What Ohio Medicaid (fee-for-service)'s documents say
The table above has every field we found for Ohio Medicaid (fee-for-service), with numbered sources. In short:
- Prior authorization. Payment for additional skilled therapy visits in a non-institutional setting can be requested through the prior authorization process in rule 5160-1-31.
- Visit limits. Without prior authorization in a non-institutional setting, payment is limited to 30 visits per benefit year each for physical therapy, occupational therapy, and speech-language pathology and audiology. An evaluation is paid not more than once per injury or condition for each type of skilled therapy.
- Who can bill. A skilled therapist (including an occupational therapist or speech-language pathologist) may render and bill for services. A hospital, physician, advanced practice registered nurse, physician assistant, podiatrist, professional medical group, ambulatory health care clinic or FQHC or RHC may bill on behalf of a rendering provider.
Check Ohio Medicaid (fee-for-service)'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.