How to Document Co-Treatments in IEP’s

GUEST BLOGGER: Kathryn Biel.

Marcia submitted this clinical question:

We’ve had some discussion around co-treatments and how best to document them in IEP’s — I’d love to get some input as to what is happening in other districts — is it being specifically documented on the service delivery page, additional information, and if so how?? (ie: for a 1 hour co-treat small group with PT & SLP — how is that documented in the IEP?? Is it in the grids as 30 minutes for each?? 1 hour for each??). Thanks in advance — I look forward to getting feedback from this group! 

This one I think will vary, depending on state regulations and reimbursement issues. I’m in New York, so I can only speak to what we’re doing in my region. This is also my understanding, so please feel free to jump in and tell me if I’ve got it wrong. I’ve never been allowed to put a co-treat on an IEP, mostly due to Medicaid reasons. Medicaid does not allow co-treats. According to most districts I’ve been in, if the service is on the IEP, it should be reimbursable. I’ve worked in districts with a very high Medicaid-eligible percentage, so every IEP was treated as if it were being submitted to Medicaid (also because you can retroactively claim Medicaid as well).

So, let’s try this example: A PT/SLP co-treat that is 1 hour long, which takes place one time per week. PT sees the student one more time individually and speech has two more individual sessions. On the co-treat day, PT and SLP would each bill for 30 minute individual sessions but at different times (10-10:30 for PT, 10:30-11 for SLP). The Related Services would be listed at PT two times per week, individual, 30 minute sessions, and SLP would be listed as three times per week, individual, 30 minute sessions.

Personally, I would then add in a PT and an SLP consult under Support for School Personnel and describe the consult to include the co-treat. This way, you have the accountability in the IEP to carve out the time in your schedules to include the co-treat. I would also state the need for/purpose of the co-treat somewhere in the Physical Development Section of the IEP.

Co-treats are a vastly underutilized service, in my book. Sometimes, to get around this, the OT and PT staff (because we share treatment space) will plan one activity that we do together with our students. This doesn’t help with the PT/SLP or SLP/OT co-treat. Obviously, scheduling becomes another issue as well.

I would love to hear how other therapists would or do document co-treats. Please let me know, and Margie, I hope this helps! 

~Kathryn Biel, PT, DPT


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5 Responses to How to Document Co-Treatments in IEP’s

  1. rhona melberg says:

    I do co-treatments with OT quite a bit. We usually each list our service on the IEP as separate items on the service delivery page, but will add in the comments that it is a co-treat. We also adjust the number of minutes per cycle accordingly. For example, both PT and OT are doing 2x’s 30 with one of those as a co-treat. We would each list two separate items on the grid, PT 1×30 with time of 30 minutes for weekly minutes and PT as 1×30 with the comment: co-treat with OT and weekly minutes as 30. OT would have two similar items but on the one listed as co-treat, changes the minutes per week to 0 so it does not affect the total service delivery on grid for teacher/administrator. We are planning to ask our administration to place a service provider on the drop down list to read OT/PT to eliminate the duplication for the co-treat on the grid. As for medicaid, one of us will submit as a visit so there is no duplication or co-treats listed for billing them. Hope this helps.

    • Rachna Stephens says:

      If their IEP says Speech 2x’s, 30 minutes and OT 2x’s, 30 minutes, and they want to co-treat, should the co-treatment session be 30 minutes or 1 hour long?

  2. Alicia Kollmar says:

    It shouldn’t have to be indicated in the IEP;IDEA does not require it to be. As a related service are we documenting co-treatments with special ed teachers when we both provide inclusion therapy in the general education classroom? The actual time we plan to spend with a student is what should be listed on the IEP; I’ve done plenty of co-treatments in which both disciplines could address their discipline-focused objectives for the entire session. If it makes sense to do it with another professional why do we need to indicate this on the IEP?

    School-based therapy should be IDEA-driven, not Medicaid driven.I think children (and taxpayers) are often done a disservice when Medicaid is the primary model to providing therapies in the schools. I also think that if we are basing school-based treatment on reimbursement from Medicaid it puts us in an ethical bind. I intentionally don’t know which of my students have Medicaid,and I don’t think it’s ethical to make treatment decisions based on whether a child is Medicaid eligible or not (I document for all students in our Medicaid system and the vendor chooses which are billable). Sometimes the most appropriate way to spend a session is to provide skilled observation in the classroom–can this student perform without your intervention? What aspect of the activity is keeping him from being more independent? Is there a way you can cue the teacher to cue him? Medicaid wouldn’t pay for that kind of service, but it may be the best way to ultimately help a child be more independent.

  3. Joanne Mortimer says:

    In Rhode Island, within our district, we would write it just as Kathryn said and for the same reasons EXCEPT…consult would not be specific in regards to co treat. That is a discussion with the parent and it ( co treat) may not always happen consistently so it would not be written in. Also, in IEP training there is no language for co treat nor definition for educators or parents to understand. Most parents are very agreeable . Also, when it is a new student, you may need time to evaluate weather co treat is beneficial or not. Therefore, you don’t really want it “set in stone”. Just my opinion….

  4. Gail Marinaccio says:

    I work in NYS for an agency that contracts with many local school districts. The way the districts include it on the IEP differs amongst the various districts. Some list it as an individual OT/PT co-treat for 30 minutes. Others list it as an individual session and note that #of PT sessions will be provided as co-treat with OT or Speech. In regard to Medicaid reimbursement, only one discipline would provide billing information for a session since per Medicaid guidelines two services cannot be provided simultaneously. We have developed an internal system to ensure that the guidelines are followed.

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