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CignaCommercial · Prior Auth · Coverage · Physical Therapy, Occupational Therapy, PM&R (Physical Medicine & Rehab) +1 moreHigh impact

Outpatient hospital physical and occupational therapy site-of-care review

Effective date
Oct 1, 2025
Identified
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.

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What to do

Action · 3 steps
01Before 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.
02Update staff on new ASH Site of Care Portal access and review requirements per policy 0600.
03Attend training sessions September 15 - November 5, 2025.
If missed: Failure to obtain approval may result in coverage denials for hospital-based PT/OT services.

Original notice

Outpatient hospital physical and occupational therapy site-of-care review
providernewsroom.com · Always check the source before changing claims.
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Related policy hubs

Cigna policiesPhysical TherapyOccupational TherapyPM&R (Physical Medicine & Rehab)Orthopedics

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