Prior approval for therapy services after the first ten services per provider per calendar year require prior approval before the services begin. Prior approval requests will be evaluated for the number, frequency, and duration of treatments. The number of services approved will be based on the documented diagnosis, history and goals. The frequency of services will be determined by the provider not to exceed one treatment per day. Medicaid physician consultants will review and evaluate requests for continued service.
Services are for treatment of medically oriented disorders and disabilities.
A new treatment plan is necessary defining the new goals. A new medical summary from the physician must also be attached. Additional requests should also include any supplemental data such as past treatment, progress made, family problems that may hinder progress, and a definite termination date. Medicaid physician consultants will review and evaluate requests for continued service in accordance with the process and criteria set forth in R414-21. Physical therapy reimbursement procedure codes and instructions are found in the Physical Therapy Provider Manual.