Harvard Pilgrim Health Care Home
  HPHConnect
 
  Learn more.
  Sign up for HPHConnect.
Medical Management
E-Transactions
HPHConnect
Pharmacy
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Newsroom
Office Support
Products
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
 
Print    Text Size

Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

June 2014

Physical and Occupational Therapy: Payment for Initial Evaluations 


Harvard Pilgrim’s physical and occupational therapy payment policy covers one initial evaluation per episode of illness. Harvard Pilgrim denies subsequent initial evaluations performed within 60 days of the original evaluation. Subsequent evaluations may be reimbursed upon appeal under certain circumstances, including:

  • Functional therapy is medically necessary for a different condition and a significant change in treatment is necessary
  • A member has a new occurrence or exacerbation of a disease/ injury following remission
  • A member has surgery for the same or related condition, interrupting or following a course of functional rehabilitative therapy

When filing an appeal, please be sure to include substantiating documentation supporting the necessity of a new evaluation.  For more information, please refer to the Physical, Occupational, and Speech Therapy Payment Policy.

Email this article to a colleague   

Receive Network Matters by e-mail

Network Matters Archives

Download printer-friendly version

HPHCURRENT EVENTS

Trainings Available for Connecticut Providers

Credentialing of Urgent Care Centers

GIC Product Updates Effective July 1

CLINICIAN CORNER

Prior Authorization Requests for Spine Procedures Accepted Beginning June 23

Substance Abuse and Depression in Primary Care

Physical and Occupational Therapy: Payment for Initial Evaluations

OFFICE ASSISTANT

CMS 1500 (08/05) Form No Longer Accepted

Reminders for Better Claims Processing

PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network

Annmarie Dadoly,
Editor

Kristin Edmonston,
Production Coordinator