UnitedHealthcare (UHC) Community Plan has issued an Outpatient Physical and Occupational Therapy Coverage Determination Guideline with an effective date of December 1, 2021. This Coverage Determination Guideline only applies to the states of Arizona, California, Hawaii, Kansas, Maryland, Michigan, New York, Ohio, Rhode Island, Virginia, Washington, and Wisconsin; however, this Coverage Determination Guideline has links to Outpatient Physical, Occupational and Speech Therapy Coverage Determination Guidelines for the states of Florida, Indiana, Kentucky, Nebraska, New Jersey and North Carolina.
If you practice in one of the above mentioned states, this is definitely an article you want to read and understand. To access the Coverage Determination Guideline for all of the above mentioned states, 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.
After reading through this I notice two things for further clarification.
1. UHC is now requiring Physician referral even in states that have Direct Access which effectively removes Direct Access?
2. UHC is allowing 4 visits with the physician referral without authorization. Any further appointments needed will require submitting for Authorization correct?
Even though your state practice act may allow Direct Access, this does not mean an insurance carrier must accept Direct Access and they can still require a physician referral for outpatient therapy services. If you have questions regarding this updated policy, you would want to contact UHC.