Point32 Outpatient Physical and Occupational Therapy Services Form

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.