CHANGES TO PRE-AUTHORIZATION REQUIREMENTS FOR UNIFORM MEDICAL PLANS IN 2020
Uniform Medical Plans have some new pre-authorization guidelines that started on March 1, 2020. Any CPT codes associated with physical, speech and occupational therapy services under the Physical Medicine Program are subject to “pre-authorization for more than six visits per injury or episode of treatment…” The codes under Physical Medicine that require authorization after six visits are: 92507, 92508, 92521, 92522, 92523, 92524, 92526, 92597, 92607, 92608, 92609, 92610, 92626, 92627, 92630, 92633, 95851, 95852, 96105, 97012, 97014, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97110, 97112, 97113, 97116, 97129, 97130, 97139, 97150, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97530, 97542, 97750, 97755, 97760, 97761, 97763, 97799, G0151, G0152, G0157, G0158, G0159, G0160, G0283, S8950, S9128, S9129, S9131, S9152 (Members aged 17 and younger: Select pediatric diagnosis codes are excluded)
The CPT code 97112, used by some of our LMT members, is subject to the new pre-authorization rules. Our recommendation for best practices is to use the pre-authorization tool in Availity and it will direct you if authorization is required. Pre-authorization should be obtained from EviCore for these services.
The CPT codes 97124 & 97140 for massage services are not subject to these new pre-authorization rules. The new documentation for 2020 benefits on the Uniform Medical Plans can be found online. There are slight variations in the language and benefits pertaining specifically to Massage Therapy depending on your client’s specific plan. Most read as follows:
NOTE: They are distinguishing between preferred, participating and out-of-network providers. In this version, only preferred is covered. There is some variation in the other plans. We have been informed that in Washington, almost all contracts with UMP/Regence are Preferred (PPO) contracts. It is very rare that a provider is not issued a PPO contract. If you have any concerns, contact UMP/Regence.
We have provided links to the full document of each plan here for your convenience below along with further information about the Physical Medicine Program and Pre-Authorization Guidelines and Codes.
Disclaimer: These statements and external links have not been reviewed by an attorney and are our best interpretation of the new rules and information provided by UMP and Regence as WSMTA understood it at the time this article was written (Early March 2020). We encourage you to contact UMP/Regence representatives, consult their website or use Availity to confirm authorization requirements. WSMTA and its representatives assume no responsibility for errors.
Health Savings Accounts
On October 30, 2019, the Washington State Massage Therapy Association (WSMTA) Clinical Practices Program sponsored an in-person consultation/CE with Lori Taylor, licensed insurance broker, on Health Savings Accounts (HSAs). She included what HSAs are, how our clients can set them up, how to contribute to them and how to utilize them to cover our services. Massage therapy is an “eligible expense" if the patient has a prescription, letter of medical necessity or a doctor's directive on record (in their IRS tax file) to verify “qualified HSA medical expense". We hope to set up another in-person follow-up meeting with Lori Taylor in the near future. In the meantime, here is a brief overview of the information she shared.
What We Do For You
In Washington State, massage therapists are in a unique position, licensed by the state and credentialed by insurance as health care providers. LMTs are included in insurance provider networks. The Clinical Practices Program (CPP) mission is to be a communication portal (conduit) to address issues that impact clinical practices at the state level, while bringing best practice information to individual massage therapists and clinics. We bring our voices, our knowledge, our experience and collaborative approach to Washington State's regulatory, legislative and insurance arenas. We also prioritize effective communication with our members as well as other professional organizations in the healthcare field, particularly rehabilitation therapy.
Our current and ongoing focus is to provide the most up-to-date and accurate information for Best Clinical Practices and for compliance with our massage laws as well as other regulations that apply to healthcare providers. We seek and participate in opportunities to work with networks and insurers on behalf of Washington LMTs to address issues including but not limited to credentialing, improving access to provider networks, network adequacy, prior authorization requirements, payers compliance with reimbursement regulations.
The Coding and Documentation Work Group
This group is a subcommittee under the Clinical Practices Program. Our focus is to research, network and share resources on issues of coding, documentation and other key components of clinical practice. Our goal is to share information and provide tools for licensed individual practitioners and clinical group.
Our Board and Committee members are all unpaid volunteers working for you. If you have a story idea, an educational experience or ideas to share, please contact us. Please specify your interest in the Clinical Practices Group, our coding subcommittee or if you are looking for volunteer opportunities. cpp@myWSMTA.org
Continuing Ed Audits
Every month the Department of Health audits 2% of the license renewals which have continuing education due. A shocking 50% of therapists fail the audit. This is not always due to a lack of education hours, but can also be due to not having hours in the required categories. The Board of Massage has developed a handy tracking form which lists the requirements and space to enter your continued education classes.
Print out the form, write in any classes when you take them, attach your certificate, and you are ready for a successful audit.
There will likely be some changes to CE requirements in the near future. We will let you know when the regulations become effective and supply you with the link to the updated form.