CommercialPrior AuthHigh impact
Outpatient hospital physical and occupational therapy site-of-care review
Cigna·Physical Therapy, Occupational Therapy, PM&R (Physical Medicine & Rehab) +1 more·Coverage
Effective date
Oct 1, 2025
We identified it
Jun 18, 2026
Summary
Effective October 1, 2025, Cigna Healthcare will require medical necessity review through American Specialty Health (ASH) for physical therapy and occupational therapy services provided in outpatient hospital settings. Providers must submit review requests after initial assessment if continued PT/OT treatment in hospital setting is needed, with approval decisions made within one business day.
Action Required
Before October 1, 2025: Providers must establish workflow to submit medical necessity review requests to ASH (833.695.1781) after initial PT/OT assessment visits when continued outpatient hospital treatment is planned. Update staff on new ASH Site of Care Portal access and review requirements per policy 0600. Attend training sessions September 15 - November 5, 2025. Failure to obtain approval may result in coverage denials for hospital-based PT/OT services.