UHC Community Plan Revises PT/OT Policy

September 13, 2021
 / 
Rick Gawenda
 / 

UnitedHealthcare Community Plan has released a revised Coverage Determination Guideline (CDG) for outpatient physical and occupational therapy services for the following states:

  • Arizona
  • California
  • Hawaii
  • Kansas
  • Maryland
  • Michigan
  • New York
  • Ohio
  • Rhode Island
  • Virginia
  • Washington
  • Wisconsin

Changes include Required Documentation for the following:

  • Initial Therapy Evaluation/Initial Therapy Visit Requests
  • Request for Continuation of Therapy Visits
  • Progress Reports
  • Re-evaluations
  • Visit Guidelines
  • Signed and Dated Physician Orders

To access the revised policy, click

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All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without prior written approval of Gawenda Seminars & Consulting, Inc.


All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.

This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

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  1. The UHC coverage determination guidelines effective 10/1/21 appear to be related to all patients medical necessity page 1 and 2 . From page 3 to 9 it appears to only to relate to Early Childhood Intervention.
    Is this correct?

  2. When reading through the changes I am somewhat confused. Does the information for signed MD notes and timed start / end for CPT codes just pertain to early childhood care? The outpatient information at the top seems normal, then the information seems to coordinate with childhood care then we need signed orders.

  3. Please confirm if authorization is required for PT/OT/ST at an outpatient hospital facility in the State of Virginia beginning 10/01/21.