UnitedHealthcare now requires members to obtain prior authorization before undergoing physical and occupational therapy at multidisciplinary offices and outpatient hospitals in four states.
1. The prior-authorization requirements for physical and occupational therapy went into effect Feb. 1 in Arkansas, Georgia, New Jersey and South Carolina.
2. Patients new to physical therapy and those seeking ongoing therapy will need to receive prior authorizations.
3. The initial patient evaluation does not require a prior authorization, but to receive reimbursement for the initial evaluation, providers must submit the patient assessment form for review. The follow-up treatment will require prior authorization.
4. Licensed medical professionals, including physical and occupational therapists, will conduct the medical necessity reviews and then notify the provider and patients of results.
5. UnitedHealthcare will deny physical and occupational therapy claims that were not authorized online, and the provider cannot bill the patient for the service.
The policy also includes the same prior-authorization requirements for speech therapy, which is not typically provided by physician groups with ASCs.