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21-415 See What News is Online for May 2021
Health Net·CA · Physical Therapy, Occupational Therapy, PM&R (Physical Medicine & Rehab)·Prior Authorization
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Jun 20, 2026
Summary
This is an informational newsletter summarizing May 2021 policy updates, including a reminder that prior authorization is required after 12 combined outpatient therapy visits (physical, occupational, and speech therapy). The first 12 visits do not require authorization.
Action Required
Billing team should verify current prior authorization workflows for outpatient therapy services ensure visits 13+ require prior auth for physical, occupational, and speech therapy. Update billing system flags if needed to track combined visit counts across all three therapy types.