If you have read one commercial insurer’s therapy policies, you have read one commercial insurer’s therapy policies. That is why I have created an extensive frequently asked questions (FAQs) page dedicated to Aetna and outpatient therapy. This Aetna FAQ page will provide you answers to some of the most common questions I receive regarding Aetna and outpatient therapy services. Questions answered include, but are not limited to: To read the answers to the above questions, click HERE.

TRICARE has updated chapters and sections within their TRICARE Policy Manual. This includes physical therapy, occupational therapy, and speech therapy sections. In addition, TRICARE updated the physical therapist assistant and occupational therapy assistant sections. To access all the policies, click HERE. Then, click on the policy you want to read. Changes within each policy will be written in red.

I receive many questions regarding how to locate outpatient therapy policies for UnitedHealthcare (UHC) and OptumHealth Care Solutions (Optum). In this article, I will provide links to the most common outpatient physical, occupational and speech therapy policies for UHC and Optum. UHC Reimbursement Policies for Outpatient Therapy Services Optum Reimbursement Policies for Outpatient Therapy Services I hope you found this article helpful and you utilize all of the outpatient therapy policies in this article. Thank you for being a Gold Member!

Physical therapy and/or occupational therapy visits performed by care providers contracted by Optum Physical Health require prior authorization, which includes the plan member’s initial evaluation. In addition, Optum Physical Health has specific clinical and reimbursement policies pertaining to outpatient therapy services that contracted providers must be aware of and adhere to. To access Optum Physical Healths’ clinical and reimbursement policies as they pertain to outpatient therapy services, click I hope you found this information helpful. Thank you for being a Gold Member!

UnitedHealthcare Oxford has revised their outpatient physical and occupational therapy clinical policy with an effective date of October 1, 2020. To access the revised policy, click I hope you found this article helpful. Thank you for being a Gold Member.

UnitedHealthcare Community plan has revised one clinical policy pertaining to cognitive rehabilitation, 3 coverage determination guidelines pertaining to outpatient physical, occupational and speech therapy services and 2 utilization review guidelines pertaining to outpatient physical, occupational and speech therapy services. The following policies have been revised with an effective date of April 1, 2020 except for Cognitive Rehabilitation which became effective March 1, 2020: I hope you found this article informative and will assist you treating and billing UnitedHealthcare Community Plan beneficiaries for dates of service on and after April 1, 2020. Thank you for being a Gold Member!

UnitedHealthcare Oxford has revised several of their clinical policies pertaining to outpatient physical, occupational and/or speech therapy services. The following policies have been revised with an effective date of April 1, 2020: I hope you found this article informative and will assist you treating and billing UnitedHealthcare Oxford beneficiaries for dates of service on and after April 1, 2020. Thank you for being a Gold Member!

Palmetto GBA, Medicare Administrative Contractor for the states of Alabama, Georgia, North Carolina, South Carolina, Tennessee, Virginia and West Virginia, have revised their physical therapy, occupational therapy and speech therapy local coverage determinations (LCD’s). The effective date for the revisions for all 3 LCD’s is January 1, 2019. To access the revised LCD’s, log into your Gold Member account and click on the following titles below