Osteopathic Manipulation, Speech Therapy, Physical/Occupational Therapy and Chiropractic Therapy Guidelines
Benefits for these services are subject to the following guidelines:
- 20 visits are allowed per calendar year without certification. A maximum of 60 visits are allowed each calendar year.
- Treatments that exceed 20 visits per calendar year must be referred to the Health Care Management Unit (HCMU) and the appropriate professional consultant for review. Manipulative therapy performed by an osteopath or medical doctor is also subject to these guidelines.
- Speech therapy is covered for restoring existing speech lost due to disease or injury. Therapy must be expected to restore the level of speech the member had before the disease or injury. It is not covered for learning disabilities or birth defects. The speech therapy benefit is limited to 60 visits per year. For ages 17 and younger, all speech therapy requires certification through HCMU. For ages 18 and older, certification is not required.
Referral forms for chiropractic, physical medicine, occupational therapy, physical therapy and speech therapy are completed and submitted to HCMU to initiate the certification process. The professional consultant can subsequently request additional documentation from the provider. The appropriate forms are available online at www.ok.gov/sib/Providers/Provider_Forms/index.html.
The following information is required on the referral form:
- Summary of the case
- Approximate length of time treatments will be necessary
- Long/Short-term goals
The following information may be requested by the professional consultant to support medical necessity:
- Complete treatment plan
- History and physical
- Assessment of the patient’s response to treatment as determined during the initial examination and reevaluation
- Progress notes