Update to Changes to Prior Authorization Requirements for Physical Therapy Visits
| Date: | July 10, 2024 |
| From: | Health Plan |
| To: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Providers and Facilities |
| Type: | Informational/Regulatory |
| Subject: | Update to Changes to Prior Authorization Requirements for Physical Therapy Visits |
| Business: | Medi-Cal Managed Care |
To improve member access to services and provider experience, Health Plan is implementing a change to the authorization requirements for Physical Therapy (PT).
Effective the date of this alert, Prior Authorization is not required for outpatient PT with an in-network provider. This applies to both free-standing locations or hospital campus-based services within the Health Plan service area.
PT provided as part of an acute inpatient admission or rehabilitation stay, does not require a separate authorization.
Members residing at a Long-Term Care (LTC) level of care (beyond the initial 45 days) require a separate prior authorization for PT.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website WWW.HPSJ-MVHP.ORG
