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.
http://www.chcpf.state.co.us/HCPF/Pdf_Bin/B0200119.pdf
Outpatient hospital physical therapy or occupational therapy
requires a PAR as outlined in the Medicaid Bulletin from June,
2004, B0400177.
http://www.chcpf.state.co.us/ACS/Pdf_Bin/B0400177.pdf
Further bulletins outline additional information for PT or OT
PARs, including, but not limited to the following:
A blank example of a PAR form for PT or OT services is
included at the following website:
http://www.chcpf.state.co.us/HCPF/Pdf_Bin/PARformPTOT.pdf
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.)
- If the PAR is submitted for services delivered by an
independent therapist, the name and address of the
individual therapist providing the treatment must be present
in field #24 of the PAR.
- The Medicaid provider number of the independent
therapist must be present in PAR field #28.
- The billing provider name and address needs to be
present in field #25 on the PAR.
- The billing provider’s 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.
- 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
- a medical prescription from a Colorado licensed M.D.
- 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.
CFMC prepared this
material with input from the Colorado Department of Health
Care Policy and Financing. The contents do not necessarily
reflect CDHCPF policy.
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