Authorization Requirement Changes for PT/OT/ST

Date: 02/16/24

A Message for PT/OT/ST Providers. Please share with your team.

Based on provider feedback, Sunflower Health Plan is making changes to authorization requirements related to Physical Therapy (PT), Occupational Therapy (OT) and Speech Therapy (ST) services for dates of service on and after April 1, 2024.

Physical Therapy Services:

Physical therapy services for Sunflower Medicaid members will automatically approve eight visits per member per calendar year. Prior authorization to obtain these eight visits must still be submitted and registered via the Evolent RadMD website or the call center. The initial evaluation continues to not require prior authorization unless treatment is also rendered during that visit. Subsequent visit requests for physical therapy authorizations will continue the same process currently in place and will be reviewed for medical necessity.

Should you have any additional questions, please contact Sunflower Health Plan Provider Services.

Occupational Therapy:

For occupational therapy service dates on or after April 1, 2024, Sunflower will no longer require prior authorization.

Speech Therapy Services:

For speech therapy service dates on or after April 1, 2024, Sunflower will no longer require prior authorization.

If you have questions about this bulletin or other provider resources, please contact your Provider Relations Representative or call Customer Service at 1-877-644-4623.