Physical Medicine Management

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.

Frequently Asked Questions


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

Prior Authorization

Extension Request


Authorization Requirements

For additional information and resources on submitting authorizationsCLICK HERE.


High Performing Providers

The High Performing Provider (HPP) designation is replacing the former Pathways Program effective January 1, 2025, for providers in all Highmark service areas. It is designed to give Highmark a formal process and framework for identifying and rewarding high-performing providers based on a defined set of metrics, allowing qualifying providers to have greater self-management.

For more information, read our Special Bulletin and Frequently Asked Questions.


What is Helion?

Helion is a health care technology and services company that helps payers cultivate high-performing networks while empowering providers to operate at their best — and in doing so, help patients heal better.

You can learn more about Helion here.

Last updated on 6/11/2024 10:59:48 AM


To Top