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Practice FAQ

State Guidelines for OT and PT Services

Scroll down to see the following FAQs (in order):
• Are there state guidelines for school based OT or PT?
• Can a referral for OT/PT in the schools be signed by someone other than an MD?
• NEW!  When (does) OT require a medical referral?

Are there current state guidelines for School Based OT and PTs? Special Ed OT or PT criterion?  

There are no state OT and/or PT guidelines, but there are documents from TEA on the provision of related services and developing goals/objectives that can assist therapy practitioners working in schools to understand what is expected of them in special education in our state. Those documents, titled Related Services Q&A and Documenting Frequency, Location, and Duration of Related Services, can be found by visiting the Texas Education Agency website. click here to visit TEA website​


Must a referral for PT/OT in the school setting be signed by an MD or can it be signed by a Nurse Practitioner or Physician Assistant?

 The answer to your question lies in the TBOTE Rules and the TBPTE Rules.

On the OT side, a Non-Medical Condition does not require a referral (see 372.1 (c)). A referral for a Medical Condition must from a “licensed referral source” (see 372.1 (b)). The overwhelming majority of students OTs see in the schools fit the definition of Non-Medical Condition under TBOTE Rules.


For PTs, the list of qualifying referral sources is identified in 322.1 (1) of the TBPTE Rules, and includes the two types of credentialed professionals you refer to in your question.
One important note: It is typically the practice (although not necessarily policy or procedure) of those school districts that bill SHARS to seek physician referrals for OT and PT as that is required by CMS for Medicaid reimbursement through SHARS billing.


NEW!  A question has come up in my district about when Occupational Therapy (OT) requires a medical referral for students receiving OT services in school. Our policy manual states that we need physician’s orders on all OT students; but according to what I read on this website, OT needs physician’s orders only if the student has a medical condition and for SHARS. Can you clarify?

 It is true that the Texas Board of Occupational Therapy Examiners (TBOTE) Rules do not require a referral for occupational therapy services unless there is a medical condition as defined by the Rules. The majority of the children with disabilities we serve in school do not meet this definition and therefore do not require a referral in order for services to be delivered.

However, CMS (the Centers for Medicare and Medicaid) sets its own rules and specifically requires a referral in order for Medicaid claims to be reimbursed. The School Health and Related Services (SHARS) program is the name of the Medicaid program in Texas that allows public schools to access Medicaid reimbursement for eligible children with an IEP. According to SHARS, referrals for OT (and PT) do not have to be from a physician; SHARS determines others who are authorized to prescribe physical therapy and occupational therapy services for SHARS.

Here is a link to the most recent SHARS FAQ Document where you will find more information:



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