Changes to Prior Authorization Requirements for Physical Therapy Visits
| Date: | April 18, 2022 |
| To: | Health Plan of San Joaquin (HPSJ) Practitioners, Providers and Facilities |
| Provider Alert Type: | Informational/Regulatory |
| From: | Health Plan of San Joaquin |
| Subject: | Changes to Prior Authorization Requirements for Physical Therapy Visits |
| Business: | Medi-Cal Managed Care |
HPSJ continues to seek opportunities to improve member access to services and decrease prior authorization requirements when possible.
Effective May 1, 2022, medically necessary physical therapy services prescribed by a member’s primary care physician (PCP) or non-physician medical practitioner as described below do not require prior authorization:
- An initial Physical Therapy evaluation, and up to 6 visits for therapy services
If further visits are medically necessary, a prior authorization request should be submitted and include:
- Physician/ practitioner prescription for ongoing therapy
- Current medical report
- Physical Therapy evaluation, treatment goals, and progress to date
- Reason for further physical therapy sessions
Medical records are subject to periodic audit by HPSJ to ensure the medically necessity of
services rendered and appropriate documentation.
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
www.hpsj.com/alerts for online access to the documents shared.