Medicaid: New therapy prior authorization requirements in Maryland

Last updated: Aug. 30, 2022

Effective May 1, 2022, we’ll require prior authorization for all occupational therapy, physical therapy and speech therapy services for UnitedHealthcare Community Plan of Maryland members, ages 21 and older.

For the full list of therapy codes, reference the list of current prior authorization plan requirements for Maryland Medicaid.

• These requirements will apply whether a member is new to therapy or will continue receiving therapy
• Prior authorization isn’t required for emergency or urgent services
• We’ll deny claims if prior authorization is not on file before the date of service, and you won’t be able to balance bill the member

Medical necessity review
When you submit a prior authorization request starting May 1, 2022, we’ll review your request for medical necessity. We’ll provide an authorization if appropriate and send that determination to you and the member.

To help ensure members currently under care do not experience disruption of services, providers may initiate a continuity of care request. We’ll allow approval for the current episode of care or 90 days, whichever is less, to continue upon receipt of the request and completed plan of care.

You can submit requests for these services with dates of service on or after May 1, 2022, online using the Prior Authorization and Notification tool. Providers must submit a completed plan of care to prevent any disruption in services.

Questions?
Please visit our Contact Us page.

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