UnitedHealthcare Revises Habilitation and Rehabilitation Medical Policy

June 5, 2023
Rick Gawenda

UnitedHealthcare (UHC) Community Plan has made significant revisions to their Habilitation and Rehabilitation Medical Policy. Revisions include, but are not limited to the following topics:

  • Coverage rationale
  • Required documentation
  • Initial therapy evaluation/visits requests
  • Plan of care
  • Progress reports
  • Reevaluations
  • Treatment session notes including documentation of time
  • Addition and deletion of CPT codes

The effective date of the revised medical policy is

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  1. This policy states multiple times that a physician referral is required. Do they not allow direct access to physical therapy?

    1. You would need to check with UHC and possibly the specific UHC plan to see if they allow direct access.

  2. I noticed that under “Treatment Session Notes”, it now states that start and stop time in treatment must be documented. Is this as simple as “Time in, Time out” in our notes? Thanks!

    1. My opinion only is start and stop time in treatment would be when the therapy session starts and when the therapy session ends.