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:

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

For dates of service on and after July 1, 2019, the Centers for Medicare and Medicaid Services (CMS), as well as UnitedHealthcare (UHC), is changing which CPT code Modifier 59 must be appended to on the claim form in order for both the Column 1 and Column 2 CPT codes to be paid when provided on the same date of service. If you missed my webinar last week on NCCI edits and Modifier 59, click HERE to see the complete webinar description, objectives and to order the recorded version with handouts and Gawenda Seminars & Consulting NCCI edit reference sheet.

This article was originally published on May 20, 2019. Information has been updated as of June 3, 2019. Please read below for further details. Changes are coming to UnitedHealthcare and billing for outpatient therapy services. Failure to be aware of this change will cause your claims not to be paid beginning this summer. UHC has announced they will begin requiring the application of the therapy specific

UnitedHealthcare (UHC) Community Plan will begin Site of Care Medical Necessity Reviews and are also revising their prior authorization requirements for occupational, physical and speech therapy services. Beginning with dates of service on and after  

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

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