Q1. When a student is in a wheelchair and the physical therapist is making adjustments on the wheelchair and instructing the student on the use of the equipment, is this billable?

Therapists may bill for time spent in “hands-on” activities with a student. This includes time spent in assisting the student with learning to use adaptive equipment or assistive technology and training staff. Time spent consulting or training staff and developing or modifying the adaptive equipment is NOT billable when the student is not part of the activity.

Q2. May school districts bill for a licensed provider providing direct service through demonstration of therapeutic activity to teach a non-licensed provider how to assist the student in the classroom?

Yes, it is a billable SHARS service for PT and OT, provided it is included in the IEP and the student is an active participant

Q3. If the frequency/duration does not change from year to year and there is only a minimal change in the IEP goals/objectives, would a “new” prescription be required? Generally, goals/objectives change form school year to school year and we know the prescription is valid for 3 years unless the IEP changes. What specifically constitutes “a change” in the IEP with regards to PT/OT?

The “change in the IEP” means that there is a change in the plan of care for these services.  This in turn, would mean that an evaluation or reevaluation has been done for the student.  If an evaluation or reevaluation results in a change in the plan of care for services, that results in a change to the goals and objectives for PT services and the frequency and duration of service remain the same, a new physician's script is not required. However, if the frequency and/or duration of PT service changes, then a new physician's script is required.  If there are no changes to the prescription, the expiration date for the physician prescription is the earlier of either the physician’s designated expiration date on the prescription or three years, in accordance with the IDEA three-year re-evaluation requirement.

Q4. Do Physical Therapists have to sign Physical Therapist Assistant progress notes?

Notes do need to include the name of the supervising Physical Therapist, however, this is a Texas Board of Physical Therapy Examiners requirement and not a Medicaid requirement.