Point32Commercial Clinical Policy

Outpatient Physical and Occupational Therapy Services Form

Chat with GenHealth to automate any policy or prior auth task.


Notes: Providers must review the specific criteria set forth by CMS, NCD, and LCD guidelines.

Indications

(367509) Is the mechanical traction deemed medically necessary as per CMS guidelines, applicable NCD, and/or LCD? 

Notes: Providers must check CMS Medicare Coverage Center guidance for specific medical necessity criteria and limitations.

Indications

(367510) Does the massage therapy adhere to the medical necessity criteria as defined by CMS guidelines and local or national coverage determinations? 

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.

Book a walkthrough

Walk through this policy with us

Review how this policy can be converted into cited criteria, prior authorization checks, and operational automation.