MedicaidCoverageMedium impact
Attention LEA Providers: Guidance on Occupational Therapy Coverage and Requirements for the School-Based Medicaid Program
Louisiana Medicaid·LA · Occupational Therapy, Pediatrics·Medical Policy
Effective date
May 20, 2025
We identified it
Jun 18, 2026
Summary
Louisiana clarifies that occupational therapy services in school-based Medicaid programs must meet medical necessity requirements and have physician referrals, unlike educational OT services. Services provided solely for educational purposes are excluded from Medicaid reimbursement.
Action Required
Immediately: Louisiana school-based providers must ensure all occupational therapy services have physician referrals and documented medical necessity in written service plans before billing Medicaid. Stop billing OT services provided solely for educational purposes or academic testing. Update documentation requirements to distinguish between medically necessary and educationally necessary services.