97532
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Physician/clinician prescription or order authorizing occupational therapy.
- PA approval must be obtained before services are provided.
- An order from an authorized healthcare provider (AHP) certifying that the member meets the medical necessity criteria (Refer to section 23.3)
- Documentation that the ordering AHP is a physician, nurse practitioner, clinical nurse specialist, or physician assistant who is licensed, certified, registered, or otherwise authorized to order home healthcare services consistent with State law
Key Coverage Criteria
- Covered physical health benefits and services delivered as Home Health Services for eligible enrolled members.
- Covered behavioral health benefits and services delivered as Home Health Services for eligible enrolled members.
- Members requiring extended home health care upon discharge from the hospital.
- Cases approved by the MCO for extended home health services.
- Home Health Services for eligible Humana Healthy Horizons in Louisiana members.
- Initial evaluations (per discipline) for home health rehabilitation services.
2 Active Policies
AMBETTER-CP.BH.124 — Attention Deficit Hyperactivity Disorder Assessment and Treatment
HUMANA-HOME-HEALTH-LA-MEDICAID — Home Health - MEDICAID - LOUISIANA
Related Codes
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