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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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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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03/04/19

UnitedHealthcare Updates Habilitative Therapy Policy

UnitedHealthcare Commercial has updated their coverage determination guideline (CDG) for Habilitative Services and Outpatient Rehabilitation Therapy with an effective date of February 1, 2019. This updated CDG impacts habilitative services provided by physical therapists, occupational therapists and speech-language pathologists. To access the updated CDG, log into your Gold Member account and click

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03/04/19

UnitedHealthcare Updates Cognitive Therapy Policy

UnitedHealthcare Commercial has updated their medical policy for Cognitive Rehabilitation with an effective date of March 1, 2019. This updated medical policy impacts cognitive rehabilitation services provided by physical therapists, occupational therapists and speech-language pathologists. To access the updated medical policy, log into your Gold Member account and click

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02/18/19

Quality Measures Available for MIPS 2019 Performance Year

The Centers for Medicare and Medicaid Services (CMS) has released the 2019 MIPS quality measures available to report by physical therapists (PT’s), occupational therapists (OT’s) and speech-language pathologists (SLP’s) that practice in the private practice setting. In this article, I will provide the measures available to PT’s, OT’s and SLP’s reporting via claims and registry. Quality Measures That Can Be Reported via Claims by Physical Therapists Quality Measures That Can Be Reported via Registry by Physical Therapists Quality Measures That Can Be Reported via Claims by Occupational Therapists Quality Measures That Can Be Reported via Registry by Occupational Therapists Quality

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01/14/19

First Coast Revises Therapy LCD

First Coast Service Options, Inc, Medicare Administrative Contractor for Florida, Puerto Rico and the Virgin Islands, has revised their local coverage determination (LCD) for Therapy and Rehabilitation Services. To access the revised LCD, log into your account and click

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01/14/19

Palmetto Revises PT, OT and SLP LCD’s

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

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