REVISED PHYSICAL AND SPEECH THERAPY PRIOR AUTHORIZATION REQUIREMENTS
Absolute Total Care is committed to delivering cost effective care to our members. This effort requires us to ensure that our members receive only treatment that is medically necessary according to current standards of practice. Absolute Total Care accomplishes this goal by utilizing prior authorization and benefit limit guidelines to verify the medical necessity of a treatment.
Physical and Speech Therapy via Telehealth
- Prior authorization for physical and speech telehealth therapy services will be required for dates of service on or after August 1, 2023 and need to be verified by NIA.
- The following physical and speech therapy services, when delivered via telehealth, should be billed with modifier GT in addition to modifiers that are already required per Medicaid billing guidelines:
- Prior authorization for all other therapy services not specifically outlined above remain in effect and need to be verified by NIA.
- Benefit limits apply to all services according to existing SCDHHS and Absolute Total Care policy.
- Services identified above must meet standard requirements for medical necessity.
- Services provided pursuant to the current SCDHHS telemedicine coverage policy should continue to be billed according to those guidelines.