97530 with Texas Medicaid (fee-for-service): what the policy says
The short answerYes. Texas Medicaid pays 97530 in 15 minute units for OT, within a cap of 4 timed units (one hour) per date of service per discipline. It can be given by audio and video telehealth and treatment needs prior authorization.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · Texas. Public policy, not the member's benefits.
Texas Medicaid (fee-for-service)
TMPPM Vol. 2, Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook · Texas
| 92507 | Listed (telehealth allowed; one individual speech treatment per day) [1] |
|---|---|
| 92508 | Listed (group; once per date of service; telehealth allowed) [1] |
| 92521 | Listed (evaluation, no prior authorization) [1] |
| 92522 | Listed (evaluation, no prior authorization) [1] |
| 92523 | Listed (evaluation, no prior authorization) [1] |
| 92524 | Listed (evaluation, no prior authorization) [1] |
| 92526 | Listed (telehealth allowed) [1] |
| 97165 | Listed (oT evaluation, no prior authorization) [1] |
| 97166 | Listed (oT evaluation, no prior authorization) [1] |
| 97167 | Listed (oT evaluation, no prior authorization) [1] |
| 97168 | Listed (oT re-evaluation; telehealth allowed) [1] |
| 97530 | Listed (timed, counts toward the 4 unit daily cap; telehealth allowed) [1] |
| 97535 | Listed (timed, counts toward the 4 unit daily cap; telehealth allowed) [1] |
| Where it applies | Chronic PT, OT and speech therapy are benefits for medically necessary treatment of chronic conditions and developmental delay. All eligible clients from birth through 20 years old may continue to receive all medically necessary therapy with documentation of medical necessity. [1] |
| Diagnoses | For a speech developmental delay, language, articulation, apraxia and fluency each need at least one standardized test with a score 1.5 SD or more below the mean plus informal assessment documentation. Voice needs a medical evaluation. [1] |
| Telehealth rules | Synchronous audiovisual telehealth is allowed for OT evaluations (97165 to 97168), 97530, 97535, speech evaluations and speech treatment 92507, 92508 and 92526. Audio-only is not reimbursed. [1] |
| Visit limits | Evaluations are payable once every three years to the same rendering provider. Re-evaluations are payable once every 180 days for chronic services and once every 60 days for acute services. Timed PT and OT codes are limited to 4 units (one hour) per date of service per discipline. [1] |
| Prior authorization | Treatment needs prior authorization on the Texas Medicaid PT, OT, ST Prior Authorization Form. Initial evaluations do not need authorization. The initial request must reach TMHP within five business days of the first treatment, or earlier dates of service are denied. Chronic authorizations can run up to 180 days. [1] |
| Who can bill | Auxiliary personnel may take part under supervision, but Texas Medicaid will not pay for therapy given only by them. A licensed therapy assistant and a speech-language pathology intern (Clinical Fellow) cannot enroll as therapist providers. [1] |
| Also | Services on school premises are only allowed before or after school hours. Only school districts can deliver therapy during school hours, as School Health and Related Services (SHARS). A SHARS-eligible client can get additional Medicaid therapy only if medical necessity criteria are met. Co-treatment claims use modifier U3. [1] |
What Texas Medicaid (fee-for-service)'s policy says about 97530
97530 is the CPT code for therapeutic activities, direct patient contact, each 15 minutes. At Texas Medicaid (fee-for-service) it is listed: named in the payer's public policy. Each line below is from the cited text:
- Billed with. Co-treatment by two disciplines on the same client at the same time is billed with modifier U3, and a primary therapist must be named. (Texas Medicaid Provider Procedures Manual, Vol. 2, checked October 30, 2026)
- Units. All timed PT and OT treatment codes together are limited to 4 units (one hour) per date of service per discipline. Claims above one hour are denied and can be appealed. (Texas Medicaid Provider Procedures Manual, Vol. 2, checked October 30, 2026)
- Telehealth. 97530 may be provided by synchronous audiovisual telehealth. (Texas Medicaid Provider Procedures Manual, Vol. 2, checked October 30, 2026)
The rest of Texas Medicaid (fee-for-service)'s pediatric speech and OT rules
The Texas Medicaid (fee-for-service) row has its codes, telehealth rule, limits and authorization, each with its source. Other codes we checked at Texas Medicaid (fee-for-service): 92507. Before the claim goes out, compare it with the row in the table above.