Okla. Admin. Code § 317:30-5-291 - Coverage by category; payment rates and procedure codes
(a)
Coverage. Payment is made to
registered physical therapists as set forth in this Section.
(1)
Children. Initial therapy
evaluations do not require prior authorization and must be provided by a fully
licensed physical therapist. All therapy services following the initial
evaluation must be prior authorized for continuation of service. Prior to the
initial evaluation, the therapist must have on file a signed and dated
prescription or referral for the therapy services from the member's physician
or other licensed practitioner of the healing arts. The prescribing or
referring provider must be able to provide, if requested, clinical
documentation from the member's medical record that supports the medical
necessity for the evaluation and referral.
(2)
Adults. There is no coverage
for adults for services rendered by individually contracted providers. Coverage
for adults is permitted in an outpatient hospital setting as described in
Oklahoma Administrative Code(OAC)
317:30-5-42.1.
(3)
Individuals eligible for Part B of
Medicare. Services provided to Medicare eligible recipients are filed
directly with the fiscal agent.
(b)
Payment rates. All physical
therapy services are reimbursed per the methodology described in the Oklahoma
Medicaid State Plan.
(c)
Procedure codes. The appropriate procedure codes used for billing
physical therapy services are found in the Physicians' Current Procedural
Terminology (CPT) Coding Manual.
Notes
Added at 12 Ok Reg 751, eff 1-5-95 through 7-14-95 (emergency) ; Added at 12 Ok Reg 3131, eff 7-27-95 ; Amended at 19 Ok Reg 2922, eff 7-1-02 (emergency) ; Amended at 20 Ok Reg 1193, eff 5-27-03 ; Amended at 25 Ok Reg 123, eff 8-1-07 (emergency) ; Amended at 25 Ok Reg 1192, eff 5-25-08 ; Amended at 29 Ok Reg 477, eff 5-11-12 ; Amended at 30 Ok Reg 336, eff 1-14-13 (emergency) ; Amended at 30 Ok Reg 1163, eff 7-1-13
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