North Carolina and Virginia prior authorization for outpatient therapies: Medicaid
AI Summary
Effective November 1, 2025, UnitedHealthcare will require prior authorization for physical therapy, occupational therapy, and speech therapy services for Medicaid members in North Carolina and Virginia. The first 6 visits within 8 weeks are covered without clinical review but still require prior auth submission.
Action Required
By October 1, 2025: Billing team must update systems to require prior authorization for all PT, OT, and ST services for UnitedHealthcare Medicaid members in North Carolina and Virginia. Submit prior auth requests within 2 business days of first service date using the UnitedHealthcare Provider Portal. Include signed referral, current evaluation report/plan of care, and progress notes. Claims will be denied without proper prior authorization.
Plan Types
Medicaid
States
NC, VA
Specialties
physical-therapy, occupational-therapy, pm-r