UnitedHealthcare Community Plan Implements Prior Authorization for Therapy

July 22, 2019
Rick Gawenda

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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  1. Rick, how is this going to apply to Kentucky? And will current patient being seen have to have auth submitted as of 8/1/19 or will we be able to keep seeing our patients unobstructed? Thanks!


    1. Please read the article to which states are impacted and when the prior authorization will begin.

  2. I did, but was asking for clarification (I guess I SHOULD have used that term explicitly), if only the 4 aforementioned states were affected by this, and if other states would be affected. Thanks

    1. It applies to the states listed in the notice from UHC. If you have questions specific about your state, I recommend you contact UHC Community Plan directly.

  3. How does this work with Direct Access. In Ohio for UHC we have not needed a script from a physician for multiple years. Are you saying that as of 8/1/19 that UHC is no longer following direct access for PT’s in Ohio and will be requiring a script for all PT?

    1. UHC Community Plan = Medicaid supplement plan in Ohio. As my practice does not take Medicaid so I was unaware of this. This detail would have been helpful if it had been included.

      1. I just provide the information and it’s your responsibility to read it and determine if it applies to you or not.

    2. If you have specific questions regarding UHC Community Plan, I recommend you contact them. UHC Community Plan is not the same as UHC Commercial Plan.

  4. Un-related: Has Medicare changed and now allows unlicensed staff to treat under PT supervision and will pay

  5. Hi Rick,

    For Wisconsin, which is an open access state, if we are not an in-network provider do these rules still apply? We currently do not have a script required for commercial plans.

  6. We were told by our contracting services that our area in Ohio was put on hold until the “kinks” were worked out of the system. I have not heard it was being restarted yet, and today, one of our clerical people were told during verification that it is starting back up on September 1st. Just wondered if you heard anything additional for Ohio.

    1. I have not heard or read anything different for Ohio other than what was published in the UHC monthly bulletin.

  7. Good afternoon Rick.
    We are in the state of Arizona and contacted our UHC Community Plan representative today to start the process of prior authorization for outpatient physical therapy for new a patient per the guidelines (and 10/1/19 start date). We were told that only speech therapy, after 12th visit for patients under 21 and out of network providers require prior authorization.
    I called in again to verify this information with another representative to make sure the information we were given is correct and she was able to verify again that no prior auth is required for physical therapy. She also mentioned there were a couple other calls to their office in regards to this today.
    Hope this information helps!

    1. For Arizona, you are correct in that only speech therapy requires prior authorization and that is what is stated on page 45 of the UHC article.

  8. In our area UHC Medicare is requiring authorization for rehab services for inpatient OBSERVATION patients. They are requiring 2 functional assessments, one of our choice and one MUST be the Keele StartBack (regardless of admission dx)

    Is this happening anywhere else? Thoughts on the Keele Start Back for inpt obs patients??

    Our team sees NO relevance between the Keele and inpt OBS patients…

    Thanks in advance