Changes to Prior Authorization Requirements for Physical Therapy Visits

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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 for online access to the documents shared.

Posted on April 19th, 2022 and last modified on April 19th, 2022.