Wednesday, December 8, 2010

Therapy services limitations

FV Indiana shares the following to keep our members informed. Please note that this new limit only impacts those 21 or older. It may be helpful to refer to this memo or the contact information below for more information and to resolve questions.

Effective January 1, 2011, new limits will be imposed on Physical, Occupational, and Speech Therapies. A limit of twenty-five (25) therapy visits for each type of therapy per rolling 12-month period will apply to all members age twenty-one (21) or older.
A “visit” is defined by the type of therapy and date of service. For example, a member receives physical therapy from a provider during a one-hour visit. That member receives physical therapy services defined with procedure codes 97116, 97140, 97530, and 97532 during the visit. This is counted as one “visit” toward the member’s limitation.
Prior authorization (PA) will no longer be required for Physical Therapy, Occupational Therapy, and Speech Therapy ser-vices for members age twenty-one or older. Additional information will be available in the Indiana Health Care Programs (IHCP) Provider Manual. The OMPP appreciates your cooperation and your continued participation as providers in the IHCP.
If you have questions about this bulletin, please contact Customer Assistance at(317) 655-3240 in the Indianapolis local area or toll-free at 1-800-577-1278.
If you need additional copies of this bulletin, please download them from

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