THERAPY CRITERIA
Physical, Occupational & Speech Therapy Coverage Information - Please see VT Medicaid Physical Therapy/Occupational Therapy/Speech Language Therapy Supplement manual at http://www.vtmedicaid.com/#/manuals
FOR THE FORMS BELOW GO TO: Clinical Prior Authorization Forms
Therapy Extension Form, PTOTST, Pediatric Services (does not include home health agencies)
Therapy Extension Form, PTOTST, Adult Services(does not include home health agencies)
Therapy Extension Form, PTOTST, Adult and Pediatric Services (home health agencies only)