MedicaidDocumentationMedium impact
Occupational Therapy Referral Requirement
Illinois Medicaid - HFS·IL · Occupational Therapy·Provider Notice
Effective date
Feb 4, 2014
We identified it
Jun 20, 2026
Summary
Occupational therapy services billed to Medicaid in school settings still require physician referrals despite state law changes that eliminated this requirement for non-Medicaid services. Federal regulations continue to mandate physician prescriptions for all Medicaid-covered occupational therapy services.
Action Required
Immediately: Billing teams at schools providing Medicaid services must continue obtaining physician referrals for all occupational therapy services before billing. Update staff training to clarify that the Illinois state law change does not apply to Medicaid billing. Ensure all OT claims have proper physician prescriptions to avoid denials.