A Guide for Therapy Services Healthcare Providers 

UnitedHealthcare made headlines again when they announced new prior authorization requirements for therapy services that took effect on September 1, 2024.  

UnitedHealthcare now requires prior authorization for physical therapy, occupational therapy, speech therapy, and Medicare-covered chiropractic services when delivered in multidisciplinary offices and outpatient hospital settings. Therapy services provided in the home are exempt from this requirement.

These changes undoubtedly impact healthcare providers across various therapy services, including physical therapy, occupational therapy, speech therapy, and Medicare-covered chiropractic services.

Here are the specifics of these new requirements, their implications for healthcare providers, and transition strategies.  

 

Understanding the New Prior Authorization Requirements for Therapy Services

This new prior authorization requirement applies to UnitedHealthcare Medicare Advantage plans nationwide, with the existing requirements in Arkansas, Georgia, South Carolina, and New Jersey continuing as previously implemented. 

Additionally, these states now include Medicare-covered chiropractic services under the new guidelines.

Prior Authorization Key Changes 

Prior authorization is required for specific place of service codes

• Office (11)
• Off-Campus Outpatient Hospital (19)
• On-Campus Outpatient Hospital (22)
• Ambulatory Surgical Center (24)
• Independent Clinic (49)
• Comprehensive Outpatient Rehabilitation Facility (62)

The initial evaluation does not require prior authorization; however, prior authorization is necessary for the treatment plan, which must specify the number of visits.

Providers must submit the initial evaluation results with the treatment plan through an outpatient assessment form. A new prior authorization is needed if a patient requires additional visits than the approved therapy plan stipulates.

 

How Advantum Health Can Help

Prior Authorization Support

Our team will assist you in managing the prior authorization process, ensuring that all required documentation is accurately and timely submitted.

Patient Communication

Advantum Health will help you communicate these changes to your patients, ensuring they understand the new requirements and how they may impact their care.

Continuous Support

Advantum Health is here to provide ongoing assistance and address any questions or concerns you might have as you incorporate these new requirements.

We are committed to making this transition as smooth as possible for you and your patients. 

If you have any questions or need further support, please don’t hesitate to contact us. 

 

Sources:

The challenge tormenting revenue cycle departments

Outpatient therapy and chiropractic prior authorization requirements | UHCprovider.com

Healthcare’s dissatisfaction with payer reimbursements continues