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Authorization Creation Changes for Physical Therapy, Occupational Therapy and Speech Therapy

Date: 05/22/25

Sunshine Health is changing how Physical Therapy, Occupational Therapy and Speech Therapy codes will be reflected on authorizations. This will not impact billing. This is for informational purposes only.

These changes will take effect on May 15, 2025.

Utilization Management is unable to determine how many requested units will be utilized by the provider for each specific code. This requires outreach to the provider and an additional provider administrative burden.

This authorization process update will allow all units to be built/authorized under an umbrella code. Providers can bill under the CPT code in which the member is treated throughout the auth span.

What’s Changing

  • Authorized units for all related Physical Therapy (PT) codes will be grouped under primary code 97110
  • Authorized units for all related Occupational Therapy (OT) codes will be grouped under primary code 97530
  • Authorized units for all related Speech Therapy (ST) codes will be grouped under primary code 92507
  • Providers will no longer see a line built for each secondary code reflecting units approved.

Note: These changes will not impact provider authorization requests or billing claims.

Questions

If you have any questions, please call Sunshine Health Provider Services at 1-844-477-8313 or visit the Secure Provider Portal. Our Provider Engagement staff can also answer questions. Visit the Find Your Account Manager tool to find who supports your specialty and region. Keep up with the latest Sunshine Health provider updates by reviewing and bookmarking Provider News.

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