Physical, Occupational, and Speech Therapy Services

This policy covers initial and continued outpatient or home-based physical, occupational, and speech therapy evaluations and treatments for patients with functional impairments—such as sensory/motor deficits, inability to perform ADLs or mobility tasks, cognitive/psychological decline, cardiopulmonary deterioration, or speech/language/swallowing/cognitive-communication disorders. Services require a physician/qualified professional order, a licensed therapist’s formal evaluation and signed plan of care documenting measurable potential for improvement (standardized scores cannot be the sole criterion), are subject to member benefit limits, exclude duplicative/non‑professional or repetitive services, allow home care only when safe/adequate, and may be discontinued for plateau, lack of improvement, non‑participation, or when goals are met.

"Initial authorization for outpatient or home-care speech therapy evaluation and treatment when the plan's medical necessity criteria are met."