CommercialCoverageMedium impact
00.03.03i, Outpatient Short-Term Rehabilitation Services Included in Capitation
Independence Blue Cross·Physical Therapy, Occupational Therapy, Speech Therapy·Medical Policy
Effective date
Nov 26, 2025
We identified it
Jun 19, 2026
Summary
Policy 00.03.03i clarifies that outpatient short-term rehabilitation services are included in capitation payments for commercial plans, effective 11/26/2025. This is a reissue of existing policy with no substantive changes noted.
Action Required
By 11/26/2025: Billing team must verify that outpatient short-term rehabilitation services (PT, OT, speech therapy) are NOT being billed separately to commercial capitated plans, as these services are included in capitation. Review current billing practices and EMR/billing software configuration to ensure rehabilitation services are submitted as included benefits rather than fee-for-service claims. Contact capitated plan representatives if clarification is needed on specific service boundaries. Failure to comply will result in claim denials or contract violations.