NIA Prior Authorization for Outpatient Rehabilitative and Habilitative Physical Medicine Services (including chiropractor-provided physical therapy)
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NIA will manage utilization review and prior authorization for outpatient rehabilitative and habilitative physical medicine services (including certain chiropractic physical therapy) for Maryland Physicians Care members aged 21 and older, and describes how to request authorizations.
No material clinical or coverage changes in this revision.
Coverage and Authorization Overview
Authorization and operational coverage statements
Operational coverage/authorization stance communicated in this notice:
Provider Requirements and How to Request Authorization
Prior authorization required for chiropractor‑provided physical therapy; how to initiate
Any physical therapy services rendered by chiropractors (within scope of practice) on or after March 1, 2021 require prior authorization. Providers may initiate prior authorization beginning March 1, 2021 for dates of service March 1, 2021 and beyond via the website www.RadMD.com or by calling NIA's Call Center at 1-800-424-4836.
- Authorization requirement applies to chiropractor‑rendered physical therapy within their scope of practice.
- Authorization requests may be submitted online at www.RadMD.com.
- Authorization requests may be submitted by phone to NIA Call Center: 1-800-424-4836.
Existing process remains for non‑physical therapy chiropractic services
Chiropractic services that are not physical therapy continue to follow the existing Maryland Physicians Care process; chiropractors should use the same process currently in place with Maryland Physicians Care for those services.
- This notice does not change existing procedures for chiropractic services outside of physical therapy.
- Continue to coordinate with Maryland Physicians Care per current processes for non‑physical therapy chiropractic care.
Definitions and Scope of Services
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