Medicare Advantage: Arizona, California prior authorization for outpatient therapies
AI Summary
UnitedHealthcare is expanding prior authorization requirements for physical therapy, speech therapy, occupational therapy, and chiropractic services to Medicare Advantage members in Arizona and California starting February 1, 2026. Prior auth requests can be submitted starting January 1, 2026, and while the first 6 visits within 8 weeks are covered without clinical review, a prior authorization request must still be submitted.
Action Required
By January 1, 2026: Billing team must update workflows to submit prior authorization requests for all PT, ST, OT, and chiropractic services for UnitedHealthcare Medicare Advantage members in Arizona and California. Update billing system to flag these services for prior auth requirement starting February 1, 2026. Train staff that first 6 visits within 8 weeks still require prior auth submission but won't undergo clinical review. Authorization requests can be submitted up to 10 business days after first service date.
Plan Types
Medicare Advantage
States
AZ, CA
Specialties
physical-therapy, occupational-therapy, pm-r, chiropractic