MedicaidCoverageMedium impact
Update to Seating Assessment Benefits for the CSHCN Services Program Effective May 1, 2026
Texas Medicaid·TX · Physical Therapy, Occupational Therapy, PM&R (Physical Medicine & Rehab)·General
Effective date
May 1, 2026
We identified it
May 9, 2026
Summary
Starting May 1, 2026, Texas Medicaid CSHCN Services Program will allow billing of physical therapy or occupational therapy evaluations/reevaluations on the same date as seating assessments (CPT 97542), provided they are performed at distinctly separate times with proper documentation. Claims will undergo manual review to verify no time overlap between services.
Action Required
By May 1, 2026: Billing team must update procedures to allow same-day billing of PT/OT evaluations (CPT 97161-97168) with seating assessments (CPT 97542) for Texas Medicaid CSHCN clients. Ensure documentation clearly shows distinct separate service times to avoid claim denials during TMHP manual review. Update encounter forms to remind providers of timing documentation requirements.