Family and Children's Medicaid MA-3540 Medicaid Covered Services
xxvii. Outpatient specialized therapies
For prior approval requirements, refer to The Carolinas Center for Medical Excellence website at http://www.medicaidprograms.org/nc/therapyservices.
A. Covered Services
Evaluations, re-evaluations, and or disciplinary evaluations and/or treatment services for:
1. Audiology Services
2. Speech/Language Services
3. Occupational Therapy
4. Physical Therapy
5. Respiratory Therapy-Only when provided by Independent Practitioners
B. Non-Covered Services
1. Unauthorized visits
2. Maintenance therapy
NOTE: Relative to number 2 above and for recipients under the age of 21 in regard to EPSDT requirements, see I. and XXXVIII. of this manual section.
1. Medically necessary services are covered for recipients age 21 and over only when provided by home health providers, hospital outpatient departments, physician offices, and area mental health centers.
2. Outpatient specialized therapies do not count towards a recipient’s professional services visit limit.
3. Must be ordered by a physician
1. $3.00 per visit in outpatient hospital setting and physician's office.
2. Copayments apply to all recipients except as noted in II.E.
REVISED 08/01/11 – CHANGE NO. 14-11