Resources

• UPDATED ON 4/8/2024 – Download the physical therapy checklist
• UPDATED ON 4/8/2024 – Download the occupational therapy checklist
• UPDATED ON 4/8/2024 – Download the speech therapy checklist

• Download the Carelon Medical Benefits Management Outpatient Rehabilitative and Habilitative Services Clinical Guidelines

See the physical, occupational, and speech therapy billing codes for the procedures we review (*Note: CPT codes may vary by health plan):

Commercial

• Anthem Commercial (all applicable states except BCBS ME) *Clinical site of care review applies to all procedure codes for outpatient therapy treatment requests for members with coverage through CT, CO, GA, IN, KY, MO, NH, NV and OH.
• Anthem BCBS of ME Rehabilitation Solution
• BCBS North Carolina Commercial fully insured
• Wellpoint FL, MD, and TX Commercial

Medicaid

• Anthem Medicaid (all applicable states except IN Medicaid and BCBS of NC Healthy Blue)
• Anthem IN Medicaid
• Anthem BCBS of NC Healthy Blue Medicaid
• Anthem HealthKeepers Plus VA Medicaid

Medicare Advantage

• Anthem Medicare Advantage

Dual Eligible

• Anthem Fully Integrated Dual Eligible (NY)

• Download the Rehabilitation Solution Frequently Asked Questions (FAQs)