Kentucky Medicaid outpatient therapy updates: What you need to know
AI Summary
Kentucky Medicaid has updated prior authorization requirements for outpatient therapy services. Medical necessity reviews now start at the 21st visit per discipline per calendar year, and authorization requests for visits 21+ must include initial evaluation, re-evaluation, and updated plan of care showing progress toward functional goals.
Action Required
Immediately: Billing team must ensure all outpatient PT/OT/ST requests continue to be submitted through the Prior Authorization and Notification tool in the UnitedHealthcare Provider Portal. For visits 21 and beyond 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 authorization requirements.
Plan Types
Medicaid
States
KY
Specialties
physical-therapy, occupational-therapy