UnitedHealthcare Adds Prior Authorization to Physical, Occupational Therapy in 4 States
UnitedHealthcare now requires members to obtain prior authorization before undergoing physical and occupational therapy at multidisciplinary offices and outpatient hospitals in four states.
- The prior-authorization requirements for physical and occupational therapy went into effect on Feb. 1 in Arkansas, Georgia, New Jersey, and South Carolina.
- Patients new to physical therapy and those seeking ongoing therapy will need to receive prior authorizations.
- The initial patient evaluation does not require 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.
- Licensed medical professionals, including physical and occupational therapists, will conduct the medical necessity reviews and then notify the provider and patients of results.
- UnitedHealthcare will deny physical and occupational therapy claims that were not authorized online, and the provider cannot bill the patient for the service.