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Point32 Outpatient Physical and Occupational Therapy Services Form

Effective Date

NA

Last Reviewed

04/22/2022

Original Document

  Reference



Harvard Pilgrim HealthCare Medical Policy

Outpatient Physical and Occupational Therapy Services

STRIDE SM (HMO) MEDICARE ADVANTAGE

Subject: Outpatient Physical and Occupational Therapy Services

Policy and Coverage Criteria: Harvard Pilgrim Health Care (HPHC) utilizes Centers for Medicare and Medicaid Services (CMS) guidelines and applicable National Coverage Determination (NCD) and/or Local Coverage Determination (LCD) for medical necessity determination.