Kentucky Medicaid outpatient therapy updates: What you need to know
AI Summary
Kentucky Medicaid updated outpatient therapy prior authorization requirements under regulation 907 KAR 8:40. Medical necessity reviews now start at the 21st visit per discipline per calendar year, requiring initial evaluations, re-evaluations, and updated plans of care for authorization requests beyond 20 visits.
Action Required
Immediately: Billing team must ensure all outpatient PT/OT/ST requests continue using the Prior Authorization and Notification tool in UnitedHealthcare Provider Portal. For visits 21+ per discipline per calendar year, include initial evaluation, re-evaluation, and updated plan of care showing progress toward functional goals. Verify exempt diagnoses are listed in primary diagnosis field on claim forms to avoid unnecessary prior auth delays.
Plan Types
Medicaid
States
KY
Specialties
physical-therapy, occupational-therapy