As of March 13, 2021, providers who have migrated to the new Provider Engagement, Analytics & Reporting (PEAR) portal can now submit physical therapy (PT) and occupational therapy (OT) precertification requests electronically for Medicare Advantage members.
Requests can be submitted through the Authorization Submission transaction on PEAR Practice Management (PM). When submitting requests for PT/OT services for Medicare Advantage members, providers must adhere to the following requirements:
|
PT/OT services for Medicare Advantage members |
Precertification requirements for PT/OT providers |
|---|
Combined PT and OT visits 1 – 40 | - Providers are required to submit precertification requests through PEAR PM for these visits to notify Independence for those Medicare Advantage members they plan to treat
- Clinical information is not required for visits 1 – 40
|
Combined PT and OT visits 41 and above | - Providers are required to obtain precertification through PEAR PM for these visits
- Providers are required to submit clinical information to Independence for those Medicare Advantage members they plan to treat.
|
Site of Service | Precertification is required for services performed in the office, outpatient hospital settings, and comprehensive outpatient rehabilitation facilities. |
CPT® code exceptions | 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 |
|
For practices that have not yet transitioned to the PEAR portal, please continue to call the Utilization Management department to provide notification until your scheduled go-live date. Learn more about the PEAR portal transition here.
Learn more
For additional information, view the Authorization training materials available on the
PEAR Help Center in the Clinical section of PEAR Practice Management. You can also contact PEAR Support at 1-833-444-PEAR (1-833-444-7327).