UnitedHealthcare Community Plan of Kentucky outpatient therapy updates: What you need to know

Recent updates to Kentucky Administrative Regulation 907 KAR 8:40 clarify prior authorization and medical necessity review requirements for outpatient therapy services.

What these updates mean for you

• Outpatient physical, occupational and speech therapy (PT/OT/ST) requests must continue to be submitted through the Prior Authorization and Notification tool in the UnitedHealthcare Provider Portal for all dates of service
  • Initial evaluation and re-evaluation codes remain exempt from prior authorization 
• Medical necessity reviews will be conducted starting with the 21st visit per discipline, per calendar year. For visits 21 and beyond, authorization requests need to include:
  • The initial evaluation and re evaluation, and
  • An updated plan of care that shows progress toward functional goals and outlines the requested frequency and duration of services

Exempt diagnoses

Some diagnoses are exempt from prior authorization under 907 KAR 8:40. Please refer to the regulation for the full list of exempt diagnoses. To help ensure claims process correctly without prior authorization, exempt diagnoses must be listed in the primary diagnosis field on the claim form.