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Search results with tag "F00139"
Texas Medicaid Physical, Occupational, or Speech …
www.tmhp.comF00139 Page 1 of 2 Revised Date: 05/10/2017 | Effective Date: 09/01/2017 Texas Medicaid Physical, Occupational, or Speech Therapy(PT, OT, ST)
F00139 Texas Medicaid PT, OT, ST Prior Authorization Form
www.tmhp.comF00139 Page 2 of 2 Revised Date: 05/10/2017 | Effective Date: 09/01/2017 Texas Medicaid Physical, Occupational, or Speech Therapy (PT, OT, ST) Prior Authorization Form