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10/01/19

Prior Authorization Requirements for Florida

If you provide outpatient physical, occupational and/or speech therapy services in the state of Florida to patients who are covered by UnitedHealthcare Community Plan of Florida, you will want to read this article. Prior authorization requirements for Florida effective

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08/26/19

UHC Community Plan Adds 3 States to Prior Authorization

UnitedHealthcare (UHC) Community Plan is adding 3 states (in addition to the 4 previously announced) that will require prior authorization prior to initiating physical, occupational and/or speech therapy services. In addition, UHC Community Plan is adding site of service medical necessity reviews for all speech, occupational and physical therapy services provided in a hospital outpatient setting in 2 of the 3 states. The new impacted states are

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07/29/19

CMS Releases Proposed Rule for Calendar Year 2020

On July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for calendar year (CY) 2020 for services paid under the Medicare Physician Fee Schedule (MPFS). This proposed rule does impact providers of outpatient physical, occupational and speech therapy services in all outpatient therapy settings that does include private practices, hospital outpatient departments (including Medicare beneficiaries under Observation status and in the Emergency Department and do not get admitted to the hospital), skilled nursing facilities, rehabilitation agencies, comprehensive outpatient rehabilitation facilities and home health agencies providing outpatient therapy in a Medicare beneficiaries home. Highlights of

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07/22/19

UnitedHealthcare Community Plan Implements Prior Authorization for Therapy

UnitedHealthcare Community Plan has announced they will implement prior authorization for outpatient physical, occupational and speech therapy services in select states beginning as early with dates of service on and after August 1, 2019. In addition, UnitedHealthcare Community Plan has announced they will be conducting site of service medical necessity reviews for all speech, occupational and physical therapy services in select states. Effective with dates of service on and after August 1, 2019, the following states will be required to obtain prior authorization before implementing outpatient physical, occupational and/or speech therapy services:

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07/22/19

UHC Community Plan Coverage Determination Guideline

UnitedHealthcare Community Plan has issued a revised coverage determination guideline for outpatient physical and occupational therapy. This policy applies to the following 12 states:

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06/25/19

Anthem BCBS to Require Preauthorization for Outpatient Therapy

Effective July 1, 2019, Anthem Blue Cross patients in several states will require preauthorization to receive outpatient physical, occupational and speech therapy services. This will be true not only for new patients beginning therapy on or after July 1, 2019, but also for current Anthem patients who are being seen now and will continue to be seen for therapy on or after July 1, 2019. The states where prior authorization will be required effective for dates of service on and after July 1, 2019 are:

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04/29/19

Novitas Revises PT and OT LCD

Novitas Solutions, Inc., Medicare Administrative Contractor (MAC) for the states of Arkansas, Colorado, Delaware, Louisiana, Maryland, Mississippi, New Mexico, New Jersey, Oklahoma, Pennsylvania, and Texas as well as the District of Columbia, has issued a revised physical therapy and occupational therapy local coverage determination (LCD) with an effective date of April 18, 2019. The LCD lists the most common CPT codes utilized by physical and occupational therapists and provides indications when the CPT code would be applicable to bill and supportive documentation requirements. To access the LCD, log into your Gold Member account and click

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04/22/19

CMS Releases 2020 Medicare Advantage Final Rule

On April 5, 2019, the Centers for Medicare and Medicaid Services (CMS) issued the final rule for Medicare Advantage (MA) program (Part C) regulations and Prescription Drug Benefit program (Part D) regulations for calendar year 2020. In this final rule, CMS is implementing several sections of the Bipartisan Budget Act of 2018. One of the sections CMS is implementing is Section 50323 that will allow MA plans to offer “additional telehealth benefits” as part of the government-funded “basic benefits”. Will these “additional telehealth benefits” include physical therapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs)? Continue reading to find out.

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