As previously communicated in a Partners in Health Update^SM article, as of January 1, 2020, providers must to adhere to the following changes to physical therapy (PT) and occupational therapy (OT) precertification requirements for Medicare Advantage members in order for their claims to be paid:

• Combined PT and OT visits 1 – 40: Although precertification is not required for these visits, PT/OT providers will still need to notify the Independence Utilization Management department for those Medicare Advantage members they plan to treat. However, clinical information will not be required at the time of notification.
• Combined PT and OT visits 41 and above: PT/OT providers will need to obtain precertification for these visits as well as submit clinical information to Independence for those Medicare Advantage members they plan to treat.
• Site of service: Notification/precertification will be required for services performed in the office, an outpatient hospital setting, and comprehensive outpatient rehabilitation facilities.
• CPT^® code exceptions: Notification/precertification will not be required for the following initial evaluation or re-evaluation CPT codes:

Type of visit	PT codes	OT codes
Evaluation:	97161 97162 97163	97165 97166 97167
Re-evaluation:	97164	97168

Learn more

If you have any questions regarding these changes, please contact Linda Slaughter, Manager Utilization Management at 215-241-9540.

CPT Copyright 2017 American Medical Association. All Rights Reserved. CPT^® is a registered trademark of the American Medical Association.

NaviNet^® is a registered trademark of NantHealth, an independent company.