MedicaidPrior AuthMedium impact
Special Alert December 2025 - Medicaid Benefit: Complex Rehab Technology (CRT) Repair at Providence Health Plan
Providence Health Plan·OR · Physical Therapy, Occupational Therapy, PM&R (Physical Medicine & Rehab)·Provider News
Effective date
Jan 1, 2026
We identified it
Oct 6, 2026
Summary
Effective 01/01/2026, Providence Health Plan (Oregon Medicaid) eliminates prior authorization requirements for Complex Rehab Technology (CRT) repairs under Oregon Senate Bill 549. Providers must bill CRT repair claims using modifier RB to ensure proper claim processing and avoid denials; documentation supporting the repair must be retained but does not need to be submitted with claims.
Action Required
Previously due 2026-01-01 (date passed; verify current applicability): Billing team must implement the following changes for Providence Health Plan Oregon Medicaid (OHP) members: (1) Update billing software to require modifier RB on all CRT repair claims to indicate the service is exempt from prior authorization; (2) Configure systems to recognize CRT repairs billed with modifier RB as not requiring prior authorization; (3) Ensure claims for CRT item replacements, new equipment, upgrades, or accessories that do not meet SB 549 definition continue to receive prior authorization as appropriate. Billing team must retain internal documentation supporting each repair (description of issue, components repaired, labor and parts justification, confirmation of restored function) but do not submit with claims. Claims submitted without modifier RB may be denied or subject to prior authorization requirements.