The purpose of this study was to (a) describe the specific kinds of services provided by itinerant teachers to deaf and hard-of-hearing (DHH) students in general education settings, (b) examine the relationship between student academic performance and instructional support provided by the itinerant teacher, and (c) examine how service provision decisions are made by itinerant teachers. We used quantitative and qualitative data collected during a 5-year longitudinal study. Data were obtained from teacher questionnaires, standardized achievement tests, and interviews. Results indicated that itinerant teachers of DHH students provided direct academic instruction to 60% of students with the majority of students receiving instruction in reading and writing. They provided instruction in nonacademic areas to 80% of students with a majority of students receiving instruction in self-advocacy. Low-achieving students were the most likely to receive academic instruction from the itinerant teacher. Decisions regarding service time were influenced by student needs and performance, age, parental request, and transitions.