OHSU Massage Therapy Benefit Authorization
Rules and authorization form for Moda Health coverage of massage therapy services provided by OHSU Licensed Massage Therapists, including documentation and timing requirements for claims and prior authorization submission. Affects OHSU providers and Moda Health members receiving massage therapy.
No material clinical or coverage changes in this revision.
Coverage criteria for OHSU massage therapy services
Attestation-based coverage criteria
Payment is provided for services when the following attestation items are met and required documentation is submitted:
Provider attestation requirements
- Attestation items: I am an OHSU Licensed Massage Therapist; services being requested are for future dates of service; patient has been treated six times; therapy services will be short term in nature; patient’s condition is expected to improve with further treatment; treatment being performed is not maintenance therapy.
Each item must be attested on the form.
Maintenance therapy is not considered appropriate for continued authorization. The attestation on the OHSU Massage Therapy authorization form requires the provider to confirm that the treatment being performed is not maintenance therapy; failure to meet this attestation means the service does not satisfy the authorization criteria.
Medical necessity documentation must be submitted after the first six visits. If the required documentation is not received prior to the member's 7th visit, the claim will be denied. Providers should ensure the completed authorization form and supporting medical necessity information are faxed back before the member's 7th visit to avoid claim denial.
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