Physical and Occupational Therapy

General guidelines for therapy services include:

  • A claim has one initial window period regardless of the number of accepted body parts and diagnoses on the claim
  • Physical therapy and occupational therapy are allowed separate window periods
  • Prior authorization is required for treatment extending beyond the initial window period
  • Changing therapists during the course of treatment does not start a new window period

Therapy Window Period

  • Initial window period is 10 treatments (includes the initial evaluation) or 60 days of care, whichever comes first
  • Post-surgical (inpatient or outpatient) window is 10 visits or 60 days, whichever comes first
    • Treatment must start within 90 days after the surgery date
  • Post-manipulation window period is 10 treatments or 60 days, whichever comes first
  • Modalities are limited to 2 per visit
  • Prior authorization is required for treatment extending beyond the window period

Submitting a Prior Authorization Request for Therapy Services

Submitting a Prior Authorization Request for Independent Exercise Program or Work Hardening/Conditioning

For more information about services requiring prior authorization, please contact WSI Utilization Review Department at 701-328-5990 or 888-777-5871.