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    v1.0.28
    OpenPayerPolicy UpdatesPhysical Medicine, Rehab & TherapiesUnitedHealthcare Therapy Policy Update | OpenPayer
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    CurrentUnitedHealthcare Community PlanPolicy CS164ID.C

    Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Idaho Only)

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    This policy governs coverage administration for habilitation, rehabilitation, and maintenance occupational, physical, and speech therapy services in Idaho, including Idaho Medicaid Plus plans. Medical necessity and documentation requirements are directed to the Idaho Medicaid Provider Handbook, Provider Guidelines: Therapy Services.

    Policy Summary
    PayerUnitedHealthcare Community Plan
    PolicyHabilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Idaho Only)
    Policy CodePolicy CS164ID.C
    Change TypeAdministrative/reference update
    Effective DateSeptember 1, 2026
    Next Review DateNot specified
    Key ActionUse the Idaho Medicaid Provider Handbook, Provider Guidelines: Therapy Services, for applicable documentation requirements.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    IdahoApplicable state
    3Therapy disciplines addressed
    Provider HandbookCriteria source
    Not applicableCognitive therapy
    50+Procedure codes listed

    Therapy Coverage Criteria

    Idaho therapy services medical necessity criteria

    For medical necessity clinical coverage criteria, including documentation requirements, refer to the Idaho Medicaid Provider Handbook, Provider Guidelines: Therapy Services.

    External state-specific criteria: Apply the Idaho Medicaid Provider Handbook, Provider Guidelines: Therapy Services, for criteria governing habilitation, rehabilitation, and maintenance therapy.

    The policy does not reproduce the detailed criteria.

    Cognitive therapy is outside the scope of this policy. Evaluate outpatient cognitive therapy under the Medical Policy titled Cognitive Rehabilitation and Coma Stimulation (for Idaho Only).

    Applicable Procedure Codes

    Applicable procedure codesCPT
    92507Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual.
    92508Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals.
    92521Evaluation of speech fluency (e.g., stuttering, cluttering).
    92522Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria).
    92523Evaluation of speech sound production with evaluation of language comprehension and expression.
    92524Behavioral and qualitative analysis of voice and resonance.
    92526Treatment of swallowing dysfunction and/or oral function for feeding.
    92609Therapeutic services for the use of speech-generating device, including programming and modification.
    92610Evaluation of oral and pharyngeal swallowing function.
    97012Application of a modality to 1 or more areas; traction, mechanical.
    1–10 of 18
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    Policy Summary
    PayerUnitedHealthcare Community Plan
    PolicyHabilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Idaho Only)
    Policy CodePolicy CS164ID.C
    Change TypeAdministrative/reference update
    Effective DateSeptember 1, 2026
    Next Review DateNot specified
    Key ActionUse the Idaho Medicaid Provider Handbook, Provider Guidelines: Therapy Services, for applicable documentation requirements.
    SourceLink
    On This Page
    Therapy Coverage CriteriaApplicable Procedure CodesProvider Guidance
    Applicable procedure codesCPT
    97033Application of a modality to 1 or more areas; iontophoresis, each 15 minutes.
    97034Application of a modality to 1 or more areas; contrast baths, each 15 minutes.
    97035Application of a modality to 1 or more areas; ultrasound, each 15 minutes.
    97036Application of a modality to 1 or more areas; Hubbard tank, each 15 minutes.
    97039Unlisted modality (specify type and time if constant attendance).
    97110Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility.
    97113Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises.
    97116Therapeutic procedure, 1 or more areas, each 15 minutes; gait training, including stair climbing.
    97139Unlisted therapeutic procedure (specify).
    97140Manual therapy techniques, including mobilization, manipulation, manual lymphatic drainage, and manual traction, 1 or more regions, each 15 minutes.
    1–10 of 11
    1/2
    Applicable procedure codesCPT
    97161Physical therapy evaluation: low complexity; typically 20 minutes face-to-face with the patient and/or family.
    97162Physical therapy evaluation: moderate complexity; typically 30 minutes face-to-face with the patient and/or family.
    97163Physical therapy evaluation: high complexity; typically 45 minutes face-to-face with the patient and/or family.
    97164Re-evaluation of physical therapy established plan of care; typically 20 minutes face-to-face with the patient and/or family.
    97165Occupational therapy evaluation, low complexity; typically 30 minutes face-to-face with the patient and/or family.
    97166Occupational therapy evaluation, moderate complexity; typically 45 minutes face-to-face with the patient and/or family.
    97167Occupational therapy evaluation, high complexity; typically 60 minutes face-to-face with the patient and/or family.
    97168Re-evaluation of occupational therapy established plan of care; typically 30 minutes face-to-face with the patient and/or family.
    97530Therapeutic activities, direct one-on-one patient contact, each 15 minutes.
    97535Self-care/home management training, including activities of daily living and compensatory training, direct one-on-one contact, each 15 minutes.
    Applicable procedure codesHCPCS
    97750Physical performance test or measurement, with written report, each 15 minutes.
    97755Assistive technology assessment, direct one-on-one contact, with written report, each 15 minutes.
    97760Orthotic(s) management and training, initial orthotic(s) encounter, each 15 minutes.
    97761Prosthetic(s) training, initial prosthetic(s) encounter, each 15 minutes.
    97763Orthotic(s)/prosthetic(s) management and/or training, subsequent encounter, each 15 minutes.
    97799Unlisted physical medicine/rehabilitation service or procedure.
    G0281Electrical stimulation, unattended, for specified chronic Stage III and Stage IV pressure ulcers and other ulcers not demonstrating measurable healing after 30 days of conventional care, as part of a therapy plan of care.
    G0283Electrical stimulation, unattended, for indications other than wound care, as part of a therapy plan of care.
    S8948Application of a modality requiring constant provider attendance; low-level laser; each 15 minutes.
    S8990Physical or manipulative therapy performed for maintenance rather than restoration.
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    Provider Guidance

    Documentation Required

    Idaho Medicaid Therapy Documentation

    For medical necessity and documentation requirements for habilitation, rehabilitation, and maintenance therapy, providers must follow the Idaho Medicaid Provider Handbook, Provider Guidelines: Therapy Services.

    Denial Risk

    Cognitive Therapy Is Outside Scope

    Cognitive therapy is outside the scope of this Medical Policy and should not be submitted under it. For outpatient cognitive therapy, refer to the applicable policy, Cognitive Rehabilitation and Coma Stimulation (for Idaho Only).