MedicaidPrior AuthHigh impact
Special Alert December 2025 - Medicaid Benefit: Complex Rehab Technology (CRT) Repair at Providence Health Plan
Providence Health Plan·OR · Occupational Therapy, Physical Therapy, PM&R (Physical Medicine & Rehab)·Provider News
Effective date
Jan 1, 2026
We identified it
Jul 2, 2026
Summary
Effective January 1, 2026, Providence Health Plan (Oregon Medicaid) eliminates prior authorization requirements for Complex Rehab Technology (CRT) repairs under Senate Bill 549. Billing teams must use modifier RB on all CRT repair claims to ensure proper processing and avoid denials. Prior authorization remains required only for CRT replacements, new equipment, upgrades, or non-repair services.
Action Required
By December 31, 2025: Billing team must implement the following changes for Providence Health Plan Oregon Medicaid claims: (1) Update billing system to automatically append modifier RB to all CRT repair claims for OHP members; (2) Remove prior authorization requirement from CRT repair claim workflows; (3) Create internal documentation checklist requiring providers to retain (but not submit with claims) repair descriptions, component details, labor/parts justification, and functional restoration confirmation; (4) Update claim submission protocols to distinguish between repairs (no PA required with RB modifier), replacements (PA required), and new equipment/upgrades (PA required); (5) Train billing staff on SB 549 CRT definition and new modifier requirement. Consequences: Claims submitted without modifier RB may be denied or incorrectly routed to prior authorization review, delaying reimbursement.