Additional Information for PT and OT PARs

Prior Authorization Requests (PARs) for therapy received from independent physical therapy or occupational therapy providers is required after the initial 24 units of therapy services as indicated in the Medicaid Bulletin from January, 2002, B0200119. Medicaid Bulletins can be viewed at http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1201542321017.

Outpatient hospital physical therapy or occupational therapy requires a PAR as outlined in the Medicaid Bulletin from June, 2004, B0400177.

Further bulletins outline additional information for PT or OT PARs.

A blank example of a PAR form for PT or OT services is included at the following website: http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1201542696550.

Some items to remember about PARs for physical therapy or occupational therapy:

• Requested therapies use CPT codes. Most codes can be used by either a physical therapist or an occupational therapist. The four exceptions to this are:
  - 97001- PT evaluation used by PT only
  - 97002- PT re-evaluation used by PT only
  - 97003- OT evaluation used by OT only
  - 97004- OT re-evaluation used by OT only
• A client may receive PT and OT services at the same time. However, PT services and OT services must be requested on separate PAR forms and each must include the necessary documentation as outlined below.
• Modifiers have been designated to distinguish services of physical therapy and occupational therapy. The modifiers are GP for physical therapy and GO for occupational therapy. The modifier must be attached to the code being requested. The modifier should be listed in field # 17 on the PAR form, following the CPT code. (For example: 97004-GO.)
• The requesting provider (MD,NP,PA) name and address who has written the prescription must be present in field #24 of the Par.
• The Medicaid provider number of the requesting provider must be present in PAR field #28.
  The billing provider or individual therapist rendering services name and address must be present in field #25 on the PAR.
• The billing provider’s or therapist rendering services Medicaid number must be present in field #29 of the PAR.
• DME products cannot be on the same PAR as therapy services.
• The PAR should include documentation as outlined in the Medicaid bulletins.
  1. A service plan for the client to include:
     a. diagnosis
     b. statement of problem
     c. interventions and modalities
     d. physical location where services will be provided
     e. goals of therapy showing client, therapist and family collaboration
     f. a statement identifying the expected number of treatments within a specific timeframe to meet goals
  2. a medical prescription from a Colorado licensed MD/NP/PA. A signature on the PAR form or a copy of the prescription is acceptable.
  3. a current assessment done within the last 60 days

In order for the reviewer to adequately assess the need for services, the goals should be reasonable for the client’s condition, measurable, and achievable in a predictable period of time. If the client has received previous therapy, the length of therapy and gains achieved to date as a result of therapy intervention should also be included.

Per Medicaid bulletin B0200119, there are no retroactive authorizations.

If the client’s medical condition requires more treatments than listed and authorized on the original PAR, a subsequent PAR is required. Each PAR must include all of the required information previously noted.