Effective May 1, 2024, New York providers will be required to request prior authorization for outpatient physical medicine and home health services for members.
The change includes the following outpatient services (see the table below for more information):
- Physical therapy (PT)*
- Occupational therapy (OT)*
- Home health (HH)**
| Outpatient Service(s) |
Applicable Members and Exclusions |
| Physical therapy, occupational therapy |
This prior authorization change applies to members in Commercial plans.
*ASO, FEP, and Medicare Advantage are excluded from the prior authorization requirement.
|
| Home health |
This prior authorization change applies to members in Commercial plans and ASO groups.
**Medicare Advantage is excluded from the prior authorization requirement; FEP prior authorization is not required for initial visits, per the plan limit. If a member needs additional visits (beyond the plan limit), then prior authorization is required.
|
NEW: Highmark has made the decision not to add chiropractic CPT codes to New York’s prior authorization list. For additional information, please read the provider communication below:
Latest Provider Communication
Western New York
Northeastern New York
We have a number of resources available to assist providers with the change and the electronic authorization process for these outpatient services.
Instructional Videos
Click the links below to view the videos which walk you through the authorization process in Availity. If you experience an issue, please refresh your browser. If the issue persists, contact resourcecenter@email.highmark.com.
Prior Authorization
Extension Request
Authorization Requirements
For additional information and resources on submitting authorizations, CLICK HERE.
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Last updated on 4/22/2024 9:54:49 AM