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We're ready and eager to meet your billing needs.
Physical therapy billing in Texas turns on four rules. Direct access runs 30 calendar days and needs a signed disclosure form, and Texas Medicaid wants your prior authorization within five business days of the first treatment. Workers' comp needs preauthorization after the first six early visits and gives you 95 days to bill, while Medicare pays eight different rates across the state.
| Topic | The Texas rule | Source |
|---|---|---|
| Direct access | Up to 30 consecutive calendar days without a referral, if the PT qualifies. The patient signs a board disclosure form first. | Tex. Occ. Code §453.301 |
| Medicare contractor | Novitas Solutions, Jurisdiction H | CMS |
| Medicare payment areas | 8: Austin, Beaumont, Brazoria, Dallas, Fort Worth, Galveston, Houston, Rest of Texas | CMS locality key |
| Workers' comp rate (non-network) | $72.07 conversion factor for physical medicine in 2026, about 216% of Medicare | TDI-DWC |
| Workers' comp preauthorization | Required for PT modalities and therapeutic procedures, except the first six visits after the evaluation within two weeks of the injury or a preauthorized surgery | 28 TAC §134.600(p)(5) |
| Workers' comp billing deadline | 95 days from the date of service | 28 TAC §133.20(b) |
| Medicaid prior authorization | Evaluation: none. Treatment: required, up to 60 days per request, received within 5 business days of the first treatment | TMPPM §6.2.1 |
| Medicaid adults 21+ | Acute conditions only, up to 120 days per condition. Timed PT codes capped at 4 units a day. | TMPPM §6.1, §6.3.1 |
RuleSince 1 September 2025, a Texas PT can treat without a referral for up to 30 consecutive calendar days (Tex. Occ. Code §453.301, as amended by H.B. 4099). To use it, the PT must have been licensed for at least one year, carry liability insurance at the board's minimum, and either hold a doctoral degree in physical therapy or have at least 30 hours of continuing competence in differential diagnosis. Past day 30, you need a referral to keep treating.
Before treatment, the patient signs a disclosure form prescribed by the board. One of its four statements is that the patient's "health insurance may not include coverage for the physical therapist's services."
Our readingThat line is the billing problem in one sentence. The law lets you treat. It doesn't make the plan pay. Check the plan's referral rules before the first direct-access visit, not after the denial.
RuleFor 2026, DWC's conversion factor for physical medicine and rehabilitation is $72.07, up 2.7% on 2025 (TDI-DWC conversion factors). DWC's own quick estimate puts that at about 216% of the Medicare amount (DWC 2026 professional fees deck). That fee guideline covers care outside a certified workers' comp network (same deck). If the injured worker is in a certified network, this guideline doesn't apply, so check the network's own rate terms.
The rate only matters if the visit is approved. Preauthorization is required for PT modalities, therapeutic procedures, orthotic and prosthetic management, and the unlisted PM&R code. The one exception: the first six visits after the evaluation, when they happen within two weeks of the date of injury or of a surgery the carrier already preauthorized (28 TAC §134.600(p)(5)). Extending an approved block needs concurrent review (§134.600(q)(3)).
Here's what a miss costs. In one DWC fee dispute, a clinic billed 97110 for a 13 January 2021 visit. The carrier's approval came on 26 January, covering visits from that date on. DWC ordered $0.00 of the $243.93 in dispute (MFDR decision M4-21-1902-01).
RuleThen the clock. Bill no later than the 95th day after the date of service. If you sent the bill to the wrong carrier, you get 95 days from when you're told about the mistake, and the rebill must include a copy of the original bill, the EOB if you have one, and documentation of why the exception applies (28 TAC §133.20(b)). The other exceptions are narrow and sit in Labor Code §408.0272.
| Medicare payment area (county) | Medicare 2026 | Texas workers' comp 2026 (non-network) |
|---|---|---|
| Austin (Travis) | $29.85 | $64.40 |
| Houston (Harris) | $29.21 | $63.02 |
| Dallas (Dallas) | $29.09 | $62.77 |
| Galveston (Galveston) | $29.03 | $62.63 |
| Brazoria (Brazoria) | $28.98 | $62.54 |
| Fort Worth (Tarrant) | $28.96 | $62.49 |
| Rest of Texas (all other counties) | $28.33 | $61.12 |
| Beaumont (Jefferson) | $27.80 | $59.99 |
Our math, not a published feeCMS's 2026 relative values for 97110 (0.45 work, 0.41 practice expense, 0.01 malpractice) from the CMS 2026 file, times each area's 2026 GPCIs from the CMS localities file, times $33.4009 (Medicare's 2026 conversion factor for clinicians who aren't qualifying APM participants) or $72.07 (DWC's long calculation, from its 2026 deck). Full fee schedule amount for one unit, before any payment reductions. Novitas and the carrier's EOB are the final word.
RuleIn fee-for-service Texas Medicaid, the initial evaluation doesn't need prior authorization, but every treatment visit after it does. Each request covers up to 60 days. TMHP must receive it no later than five business days after treatment starts, and a late request is denied for every date of service before TMHP got it (TMPPM, PT/OT/ST handbook, October 2026, §6.2.1).
The order trips up a lot of requests. A prescribing provider's order to "evaluate and treat" covers the evaluation or re-evaluation, but not the treatment. The treatment order must state frequency and duration, and the order or signed request form must be dated within the 60 days before services start (TMPPM §6.2.2).
Adults 21 and older are covered for acute conditions only: a recent injury, illness, surgery or flare-up, for up to 120 days per condition (TMPPM §6.1). A recertification can add up to 60 more days. TMHP won't accept it more than 30 days before the current authorization ends, and the re-evaluation codes need prior authorization with it (§6.2.3). Patients from birth through 20 can also get chronic therapy (§5.1.2).
On the claim (TMPPM §6.3, §7.1, §7.2.1):
Patients in a Medicaid managed care plan follow TMHP's separate Medicaid Managed Care Handbook instead.
RuleTexas Part B claims go to Novitas Solutions, the contractor for Jurisdiction H. CMS announced its latest Jurisdiction H award to Novitas on 25 June 2026 (CMS). Medicare splits Texas into eight payment areas (CMS locality key): seven named metro areas, and Rest of Texas for every other county.
The gap is real money at volume. Austin pays $2.05 more than Beaumont for every unit of 97110, before any payment reductions (our math, from the CMS 2026 GPCIs and relative values in the 97110 table above).
The rules above, turned into steps a Texas practice can set up this week:
Yes, if the patient's plan covers it. Texas law lets a qualified PT treat for up to 30 consecutive calendar days without a referral, but the plan decides whether it pays. The board's disclosure form warns the patient that coverage may not apply (Tex. Occ. Code §453.301).
Yes, for modalities and therapeutic procedures, except the first six visits after the evaluation when they fall within two weeks of the injury or a preauthorized surgery. Extending an approved block needs concurrent review (28 TAC §134.600(p)(5), (q)(3)).
95 days from the date of service, under 28 TAC §133.20(b). If the bill went to the wrong carrier, you have 95 days from when you're notified of the error.
TMHP must receive it no later than five business days after treatment starts. The initial evaluation doesn't need one. A late request means the visits before TMHP received it are denied (TMPPM §6.2.1).
For the evaluation, yes. For treatment, no. TMHP wants a treatment order that states frequency and duration, dated within 60 days before services start (TMPPM §6.2.2).
Novitas Solutions, the Part B contractor for Jurisdiction H (CMS). What it pays depends on which of Texas's eight Medicare payment areas you treat in (CMS locality key).
More state guides: Florida PT billing rules and Colorado PT billing rules. If a Texas claim comes back denied, look up the code in our PT denial codes guide.
ePT Billing, which maintains this guide, is a billing company that works with physical therapy practices all over the country that audits every claim before it goes out (our services).