Skip to main content

Clarification for Some SHARS Benefit Information

Last updated on

On December 1, 2022, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual, School Health and Related Services (SHARS) Handbook to clarify the following benefit information and requirements of Local Education Agencies (LEAs) that receive Medicaid reimbursement under the SHARS program:

  • Requirements for Medicaid-enrolled students with an individualized education program (IEP) or Section 504 plan
  • Prescription requirements
  • Referral requirements
  • Eligible providers for physician services and speech and language services
  • Telehealth and telemedicine services

IEP and Section 504 Plan Requirements

The IEP and Section 504 plan requirements will be updated as follows:

  • An IEP must document disability and medical necessity.
  • A written Section 504 plan must document disability and medical necessity for audiology evaluation and management services.

Prescription Requirements

“Other eligible prescribing provider” for SHARS occupational therapy (OT) and physical therapy (PT) services is defined as an advanced practice registered nurse (APRN) under the delegation of a physician, or a physician assistant (PA) under the delegation of a physician.

Referral Requirements

A prescription may serve as a referral.

“Other eligible referring provider” is defined as follows:

  • For SHARS audiology – an audiologist referring for audiology services, an APRN under the delegation of a physician, or a PA under the delegation of a physician
  • For SHARS speech therapy (ST) services – a speech-language pathologist (SLP) with an unrestricted license to provide services independently who is referring for speech and language services, an APRN under the delegation of a physician, or a PA under the delegation of a physician

Within SHARS, Medicaid-enrolled audiologists may refer for their own services or those of another SHARS audiologist. They may not refer for any services outside of SHARS or for SHARS services of other disciplines.

Within SHARS, Medicaid-enrolled SLPs who practice independently may refer for their own services or those of another SHARS provider of the same discipline. They may not refer for any services outside of SHARS or for SHARS services of other disciplines.

Eligible Providers

Physician services may also be provided by an APRN under the delegation of a physician, or a PA under the delegation of a physician.

Speech and language services must be delivered by one of the following:

  • A qualified SLP holding an unrestricted Texas state license to provide services independently
  • A licensed SLP intern acting under the supervision and direction of a licensed SLP
  • A licensed assistant in speech-language pathology acting under the supervision and direction of a licensed SLP

Speech and Language Services

The following direct therapy procedure codes are limited to a total of one unit per day:

Procedure Codes

92507 with modifier GN and U8

92508 with modifier GN and U8

92507 with modifier GN and U1

92508 with modifier GN and U1

Telehealth and Telemedicine Services

Telehealth and telemedicine services will be separated into different subsections for clarity.

For telehealth and telemedicine services, providers should obtain informed consent for treatment from the student’s parent or legal guardian and the student prior to rendering the service.

For consistency within the Texas Medicaid Provider Procedures Manual, School Health and Related Services (SHARS) Handbook, units of service will be added for the following telehealth procedure codes:

Procedure Code

Unit of Service

92521, 92522, 92523, or 92524 with modifier GN

15 minutes

97150 with modifier GO

15 minutes

97150 with modifiers GO and U1

15 minutes

97150 with modifier GP

15 minutes

97150 with modifiers GP and U1

15 minutes

97161, 97162, and 97163

15 minutes

97165, 97166, and 97167

15 minutes

For more information, call the TMHP Contact Center at 800-925-9126.