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Good Morning
10:37:21 AM CDT
Thursday, April 17, 2014

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Utilization Review

Topics Forms & Publications Electro Medical Device Certification Request (M5)
General Information Utilization Review Guide Provider Request for Adjustment (M6)
Authorization Process Utilization Review Request (UR-C) Independent Exercise or Work Hardening/Conditioning Program Requests (C59a)
Physical and Occupational Therapy Treatment Window Utilization Review Request (UR-C) Guidelines Quick Tips for Physical & Occupational Therapists
Durable Medical Equipment (DME) Post Injection Pain Response Note  
Treatment Guidelines    

Physical and Occupational Therapy Treatment Window

WSI allows a window period for physical and occupational therapy treatment of each new claim. A new window period is not allowed if the patient changes therapists during treatment.

  • The window period for initial care and post-operative care is 10 visits or 60 days of care, whichever comes first
    • Therapy for post-op must begin within 90 days after surgery date
  • One initial window period per claim, not per body part or diagnosis
  • Modalities are limited to two per visit
  • For extension of timeframe on prior approved therapy sessions call the UR department before approval expires
  • Time extensions do not apply to initial window period
  • Window period expires 60 days from initial evaluation

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