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Texas - Speech & Language Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

In Texas, Speech-Language Pathology (SLP) services are licensed by the Texas Department of Licensing and Regulation (TDLR) and enrolled for Medicaid reimbursement through the Texas Medicaid & Healthcare Partnership (TMHP). The service provides evaluation and treatment for communication, cognition, and swallowing disorders, and is funded through traditional Texas Medicaid, managed care organizations (MCOs), and specialized programs like the Children with Special Health Care Needs (CSHCN) Services Program.

To become an approved provider, an applicant must first secure a professional SLP license from TDLR, which requires a master's degree, clinical internship, and passing the Praxis examination. Once licensed, the provider must enroll in Texas Medicaid via the TMHP Provider Enrollment on the Portal (PEP) system. Providers must also secure contracts with Medicaid MCOs to serve the majority of the state's Medicaid population, as Texas relies heavily on managed care delivery.

1. Service Definition and Scope

Speech-Language Pathology (SLP) services in Texas Medicaid encompass the evaluation, diagnosis, and treatment of speech, language, cognitive-communication, and swallowing disorders. An encounter for individual treatment is defined as face-to-face time with the patient and/or caregiver for a length of time compliant with nationally recognized professional standards.

Services may be provided by licensed speech-language pathologists, or by licensed interns or assistants under the direct supervision of a licensed SLP. Evaluations and re-evaluations are untimed, while treatment sessions include direct client time, preparation, and documentation.

2. Regulatory and Oversight Agencies

Professional licensure for SLPs in Texas is managed by the Texas Department of Licensing and Regulation (TDLR). TDLR sets the educational, clinical, and examination standards for licensure.

Medicaid enrollment and claims processing are administered by the Texas Medicaid & Healthcare Partnership (TMHP) on behalf of the Texas Health and Human Services Commission (HHSC). Providers must also interact with individual Medicaid Managed Care Organizations (MCOs) for network contracting.

3. Gatekeeping Prerequisites: Who Can Even Apply

There is no Certificate of Need (CON) or Facility Need Review required to open an SLP practice in Texas. However, to bill Texas Medicaid, the individual provider or the employing entity must hold an active, unencumbered license from TDLR.

For out-of-state providers seeking to enroll in programs like CSHCN, the provider must be located in the United States, within 50 miles of the Texas state border, and be approved by the Department of State Health Services (DSHS). Additionally, Medicare enrollment is a prerequisite for Medicaid enrollment if the provider renders services to clients eligible for Medicare.

4. Licensure and Certification Requirements

To obtain an SLP license from TDLR, applicants must hold a master's degree or higher with a major in communicative sciences or disorders. The coursework must include at least 36 semester credit hours in speech-language pathology and related fields.

Applicants must also complete a clinical internship (Clinical Fellowship) under the supervision of a licensed SLP and pass the national Praxis examination in Speech-Language Pathology. Foreign-trained applicants must submit an original evaluation from an approved transcript evaluation service.

5. Medicaid Provider Enrollment

Providers enroll in Texas Medicaid through the TMHP Provider Enrollment on the Portal (PEP) system. Enrollment requires submission of the Texas Medicaid Provider Enrollment Application, along with proof of TDLR licensure and an NPI.

Group practices must submit a Group Application and link individual performing providers. Providers wishing to participate in the CSHCN Services Program must complete additional enrollment steps and sign a specific Provider Agreement.

6. Staffing, Training and Background Checks

All performing providers must maintain active TDLR licensure. Licensed interns and assistants must practice under the direct supervision of a fully licensed SLP, and the supervising SLP is responsible for billing the services.

Medicaid enrollment requires background checks and screening for exclusion from federal health care programs. Providers must not be prohibited from participating based on conduct constituting fraud, waste, or abuse.

7. Documentation, Policies and Records

Providers must maintain comprehensive clinical and administrative records compliant with TDLR professional standards and Texas Medicaid rules (1 TAC, Part 15). Failure to create and maintain required records can result in sanctions.

Documentation must support the medical necessity of the services billed, including detailed evaluation reports, individualized treatment plans, and session notes that record the exact face-to-face time spent with the client.

8. Billing, Rates and Claims

Claims are submitted to TMHP for traditional Medicaid or to the respective MCO for managed care clients. Speech therapy treatment procedure codes must be billed with the GN modifier to identify the service as speech-language pathology.

Evaluations and re-evaluations (e.g., 92521-92524) are untimed and do not require the GN modifier. Re-evaluations of swallowing functions (92610) require the U2 modifier. Reimbursement is the lesser of the billed amount or the Texas Medicaid allowed amount.

9. Approval Sequence and Timeline

The process begins with obtaining a professional license from TDLR, which requires completing education, clinical hours, and exams. Once licensed, the provider applies for an NPI and enrolls in Medicare (if applicable).

Following licensure, the provider submits the Medicaid enrollment application via TMHP PEP. TMHP processing typically takes 30-60 days if the application is complete. After Medicaid approval, the provider must credential and contract with individual MCOs, which can add several months to the timeline.

10. Common Denials and Survey Findings

Medicaid enrollment applications are frequently delayed or denied due to missing Medicare enrollment information, failure to link a performing provider to a group application, or incomplete ownership disclosures.

Claims are commonly denied if an initial evaluation and re-evaluation are billed on the same date of service, or if outpatient speech therapy is billed on the same day as home health speech therapy (G0153) without distinct, separate times documented.

11. Key Contacts and Resources

Providers should utilize the TMHP website for enrollment applications, provider manuals, and fee schedules. The TDLR website provides all necessary forms and rules for professional licensure.

For questions regarding Medicaid policy or specific program rules, providers can contact the TMHP Contact Center or refer to the Texas Medicaid Provider Procedures Manual (TMPPM).

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