Oklahoma Medicaid Billing Exception Rules

The following outlines billing requirements for therapy and imaging services in accordance with Oklahoma Medicaid regulations.

Physical Therapy

• 421 - valid code for Physical Therapy Services
• 424 - code designated for Physical Therapy Evaluation

Note: For Physical Therapy, the state does not pay/reimburse for revenue code 420.

Occupational Therapy

• 431 - valid code for Occupational Therapy Services
• 434 - code designated for Occupational Therapy Evaluation

Note: For Occupational Therapy, the state does not pay/reimburse for revenue code 430.

Speech Therapy

• 441 - valid code for Speech Therapy Services
• 444 - code designated for Speech Therapy Evaluation

Note: For Speech Therapy, the state does not pay/reimburse for revenue code 440.

Outpatient Radiology/CT Scan/Imaging Services

Outpatient Radiology/CT Scan/Imaging Services billed with the revenue codes of 32X ,33X ,35X and 40X must include the appropriate modifiers. Failure to include the required modifier results in the calculation of a global payment amount based on the associated CPT code.

See the following for additional details...

• Oklahoma Reimbursement Tool (node)
• Oklahoma Medicaid Provider Profile
• Oklahoma Medicaid Inpatient Expected Reimbursement Detail
• Oklahoma Medicaid Outpatient Expected Reimbursement Detail