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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) +2 more·Provider News
Effective date
Jan 1, 2026
We identified it
Sep 2, 2026
Summary
Effective 01/01/2026, Providence Health Plan (Oregon) eliminates prior authorization requirements for Complex Rehab Technology (CRT) repairs for Oregon Health Plan (OHP) Medicaid members, aligning with Oregon Senate Bill 549. Billing teams must use modifier RB on all CRT repair claims to ensure proper processing and avoid denials; prior authorization is still required for CRT replacements, new equipment, and upgrades.
Action Required
By December 31, 2025: Billing team must implement the following changes for Providence Health Plan Oregon Medicaid (OHP) claims: (1) Configure billing software to ALWAYS append modifier RB to all CRT repair claims for OHP members; (2) Update claim submission protocols to remove prior authorization requirements specifically for CRT repair services (not replacements or new equipment); (3) Train billing staff to distinguish between CRT repairs (no PA needed with RB modifier) and CRT replacements/upgrades (PA still required); (4) Establish internal documentation retention procedures to maintain records of repair descriptions, components, labor justification, and functional restoration confirmation (do not submit with claims, but keep on file for compliance); (5) Update billing system validation rules to flag CRT claims missing modifier RB as requiring review before submission. CONSEQUENCE: Claims submitted without modifier RB or submitted for CRT repairs without proper identification may be denied or incorrectly subject to prior authorization delays.