Complex Rehab Technology (CRT) Repair — Medicaid (OHP) coverage and billing
Customize your policy alerts
Sign up for all Providence Health Plan policy alerts
Know when Providence Health Plan releases new policies or updates existing guidance.
Monitor payer policy activity
Defines Providence Health Plan Medicaid (Oregon) coverage, billing, and documentation requirements for repairs to Complex Rehab Technology (CRT) and explains when prior authorization is or is not required under Oregon Senate Bill 549.
Providence Health Plan will no longer require prior authorization for Complex Rehab Technology (CRT) repairs for Oregon Health Plan (OHP) members in alignment with Oregon Senate Bill 549.
Coverage Criteria for CRT Repairs
inv-01: CRT repair — covered with criteria
Covered when ALL of the following are met
Such items require specialized clinical assessment and professional repair.
Replacements, new equipment, upgrades, or non-repair services are not eligible for the PA exemption and remain subject to standard PA rules.
Claims not billed with modifier RB may be denied or may be subject to prior authorization requirements.
inv-02: Situations requiring prior authorization
PA is required when ANY of the following apply
Replacements of items that normally require PA remain subject to PA.
Adding new components or upgrades is not considered a repair and requires PA when applicable.
Items outside the CRT statutory definition are not covered by the CRT repair PA exemption and remain subject to PA.
Items that do not meet the statutory definition of Complex Rehab Technology (CRT) under Oregon Senate Bill 549 are not eligible for the PA exemption for repairs. In addition, when a CRT item is being replaced (rather than repaired), or when the service includes new equipment, upgrades, or accessories that are not part of a repair, the replacement or new/upgrade service remains subject to standard prior authorization processes.
Billing and Coding
| RB | Billing modifier RB — identifies service as repair and ensures claim is recognized as exempt from prior authorization under SB 549 |
Provider Actions and Prior Authorization
Prior authorization rules for CRT repairs
Prior authorization is not required for CRT repairs that meet the statutory definition of CRT under SB 549 and are billed with modifier RB. If any repair condition is not met (for example the item is being replaced, includes new equipment/upgrades/accessories, or does not meet the statutory CRT definition), prior authorization is required.
- PA-exempt when: item meets SB 549 CRT definition, service is a repair (not replacement/new/upgrade), and claim is billed with modifier RB.
- PA required when: item normally requires PA and is being replaced; service includes new equipment, upgrades, or accessories not part of a repair; or item does not meet SB 549 CRT definition.
Bill repairs with modifier RB
Bill CRT repair services with modifier RB to identify the service as a repair and ensure correct processing under the SB 549 repair benefit.
- Modifier RB identifies the service as a repair.
- Modifier RB ensures the claim is recognized as exempt from prior authorization and allows proper processing under the new benefit.
Denial risk if modifier RB is omitted
Claims for CRT repair that are not billed with modifier RB may be denied or may be processed as services subject to prior authorization requirements.
- Omitting modifier RB removes the PA-exempt treatment for repairs and may lead to claim denial or a PA determination.
Definitions
Medical Necessity for CRT Items
inv-12: CRT medical necessity definition
Medical necessity is tied to items being individually configured to meet the member's unique medical, physical, or functional needs and capacities for activities of daily living.
Such items support independence and require specialized clinical assessment, customization, and professional repair to maintain safety and function.
Rules for Rental and Purchase of CRT Items
| CRT item or situation | Purchase / replacement rule |
|---|---|
| CRT item that normally requires prior authorization and is being replaced | |
| Service that includes new equipment, upgrades, or accessories not part of a repair | |
| Item that does not meet the statutory definition of CRT under SB 549 but still has a PA requirement |
Documentation Requirements
Retain repair documentation (do not submit with claim)
Providers must retain detailed documentation of repair work but do not need to submit it with the claim.
- Keep documentation describing the issue or malfunction
- List components repaired or replaced
- Justify labor and parts used
- Confirm the repair restores the original function
Required documentation to retain for CRT repairs
Maintain records that fully support the repair performed, including a description of the problem, what was repaired or replaced, rationale for labor and parts, and confirmation that original function was restored.
- Description of the issue or malfunction
- Components repaired or replaced
- Justification for labor and parts
- Confirmation that the repair restores the original function
Background
Complex Rehab Technology (CRT) refers to individually configured mobility and positioning systems such as manual and power wheelchair systems, adaptive seating and positioning, standing frames, gait trainers, and related components that require specialized clinical assessment and professional repair. These items are maintained through professional repair services; under SB 549 the repair of qualifying CRT items may be treated differently for prior authorization when billed correctly.
Not Covered
Services that are billed as repairs but lack the required billing identifier (see coding section) may be denied or treated as subject to prior authorization. Also not covered under the PA-exemption are replacements, provision of new equipment, upgrades, or accessories when those services are not part of a repair, and any items that do not meet the statutory definition of CRT under SB 549 — these situations continue to require prior authorization.
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.