Name of Manual - Blue Cross and Blue Shield of Minnesota

Chiropractic, Physical,
Occupational, and
Speech Therapy
Authorization
(continued)
Coding Policies and Guidelines (Public Programs)
Outpatient physical, occupational and speech therapy services:
Initial evaluation
Any additional evaluations
Plan of Care including the following:
Member’s diagnosis
Description of member’s functional status / limitations
Treatment plan
Treatment goals (functional, measurable and time-specific)
Requested frequency and expected duration of treatment
Discharge plan
Member’s progress toward goals
Ordering practitioner
Prior Authorization Process
The timeline for decisions is up to ten business days. Decisions
will be communicated via telephone or fax, and letter. Approvals
are communicated via telephone with a letter as follow-up. Denials
are communicated with a fax copy of the denial letter and a followup
letter sent by mail.
MHCP coverage guidelines are followed for MHCP members. All
services must be medically necessary for continued coverage.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (02/07/12)
11-23