Physical and Occupational Therapy
At a Glance
Physical and Occupational Therapy
Physical and Occupational Therapy services supports providers in delivering rehabilitative care, including evaluations, treatment plans, and therapy sessions for eligible members. Providers must follow MHCP guidelines for documentation, authorization, and billing through MN–ITS to ensure compliance and timely reimbursement.
Training & Reference Materials
Authorization Form (required for faxed requests only)
How-To Guides
Submitting a Medical Assistance Reconsideration Request for Providers
Newsletters
Frequently Asked Questions
Additional FAQ documents can be found on the below attachments:
Training FAQs - OT-PT Authorization Specific Questions
Training FAQs - General Portal and Registration Questions
Training FAQs - OT-PT Benefit Limitations
OT/PT Specific Authorization Questions
Is there an escalation process if we are seeing a delay in care for patients?
Please reach out to the DHS Policy Lead with any concerns.
I keep hearing confusing information about visits and units. What’s the difference?
- The threshold is based on visits, not units: The limit (e.g., 14 or 24) refers to the number of dates of service—each visit counts as one, regardless of how many units are billed during that visit.
- Authorization requirements: Even though the threshold is based on visits, the authorization itself must match the claim exactly in terms of:
- Procedure codes (the specific CPT or HCPCS codes authorized)
- Units (the exact number of units approved for each code)
What are the authorization requirements for OT and PT services?
See the Occupational and Physical Therapy section in the Rehabilitative Services of the MHCP provider manual. Occupational and Physical Therapy Services and Authorization Requirements
Will requests be denied if supporting documents are not included?
Yes. Required documentation can be found in the MHCP provider manual Authorization Requirements.
Are there published guidelines on medical necessity?
Reviewers use a patient-centered approach to support best outcomes for MA recipients. Documentation should show a clear connection from the evaluation àplan of care à progress notes, with measurable changes at each visit.
Are there any differences between pediatrics versus adults needing prior authorization, or is this for all patients?
This applies to all Medical Assistance patients regardless of age
What about speech therapy?
At this time, only occupational and physical therapy require an authorization.
If a patient is being seen for both PT and OT, do we submit two requests or one?
Submit two separate requests, one for PT and one for OT.
Who is interpreting the documentation and determining approvals or denials?
Acentra Health employs MN-Licensed occupational and physical therapists to complete clinical reviews.
Does the OT/PT visit count include IP rehab visits?
Yes. The benefit limit is per recipient, not per provider or service location.
What is the process for any denials?
Please review the resource “How to Request a Reconsideration” found here https://mhcp.acentra.com/provider-resources/ and the How-To guide “Submitting a Medical Assistance Reconsideration Request for Providers” found here under the Forms and How-To Guides Section: https://mhcp.acentra.com/physical-and-occupational-therapy/