Physical Therapy
Adopted Rule Amendment January 2012
§346.1, Educational Settings
(d) The types of services which may require a physician's referral in the educational setting include the
provision of individualized specially designed instructions and the direct physical modeling or hands-on
demonstration of activities with a student who has been determined eligible to receive physical therapy
as a related service. Additionally, they may include the direct provision of activities which are of such a
nature that they are only conducted with the eligible student by a physical therapist or physical therapist
assistant. The physical therapist should refer to §322.1 of this title (relating to Provision of Services).


**PT Rules 2014**
CHAPTER 322. PRACTICE ...................................................................................2
§322.1. Provision of Services.......................................................................................................................................... 2

PT Practice FAQ (Documentation)

Do the Rules require that a plan of care be certified by the referring practioner?

The board’s rules do not require the referring practitioner to sign the plan of care, nor do the rules address when a referral source needs to approve continuation of services. If a referral does not specifically address duration or frequency of treatment, it is up to the PT’s professional judgment how often to notify the doctor of the patient’s status and need for further treatment. However, if a referral is specifically limited to a duration of time, it could be said to expire at the end of that time. If a referral expires, it cannot be used as the authorization to treat unless the PT receives approval to continue from the doctor.

Payers such as Medicare or Medicaid may have rules that require the referral source to sign the Plan of Care, and to do other things not required by the PT board. You must follow payer rules to be eligible for reimbursement, but those rules are independent of the board’s rules regarding the legal practice of physical therapy in Texas. For information about payer requirements, you must contact the payer. (3/3/2010)

SHARS FAQ September 4, 2014

C6. How often must a referral/prescription for physical therapy/occupational therapy or speech therapy services be obtained?
A prescription is required after the initial assessment and must be renewed at least every three years. If the prescription or referral has an end date, the prescription must be renewed prior to the end date. For example, some physicians will only write a prescription that is valid for one year. In addition, when there is a change in the plan of care, a new referral/prescription is needed.

C7. What type of change to the IEP would necessitate a new prescription or referral?
Determinations concerning the need for new prescriptions or referrals are decisions made by the student’s ARD committee. In addition, when there is a change in the plan of care, a new referral/prescription is needed. For example, if the duration time for treatment sessions change or the number of sessions per week change, a new prescription/referral is needed.

C8. If the goals/objectives change for an OT/PT student from year to year, but the frequency & duration of service does NOT change, is a "new" prescription required?
No. A new prescription is not required.

See "Medicaid and SHARS Q&A" tab.

Occupational Therapy

3. Q: Do I need a referral for school practice?
A: The TBOTE Rules do not require a referral for OT for non-medical conditions. Based on the definition in the Rules, this would include ADHD. Other examples of non-medical conditions would be cerebral palsy, learning disabilities, autism, and spina bifida. This is not an exhaustive list, and in all cases the presumption is that the child with the disability is otherwise healthy. In each of these cases, the disability is static, not acute or progressive. Many folks take medication to help manage symptoms (antihistamines, decongestants, seizure meds, stimulants for ADHS etc.). It is important to know if the child is taking a medication so precautions can be adhered to, but just the fact that someone takes medication does not require the OT to get a referral.

Examples of medical conditions that would require a referral would be for a student with cancer, rheumatoid arthritis, dysphagia (whenever a child is eating a modified meal at school), for a student for whom you are providing splints, muscular dystrophy (might not be needed during times of stability, but would be needed during times where the student is clearly degenerating and functional or medical status is changing), or when a CP child has a rhizotomy or gets a baclifen pump. The flu or another virus is not cause for a medical referral, but significant change in medical status or functional condition would be. At some facilities they get a medical referral on an annual basis, but the Rules do not specify a frequency.

For comprehensive information on the current OT Rules regarding physician referrals, please read:
OT Rules 2013
CHAPTER 372. PROVISION OF SERVICES..................................................................20
§372.1 PROVISION OF SERVICES..........................................................................................20

Sample Physician Referral Form requests