MedicaidPrior AuthMedium impact
Kentucky Medicaid outpatient therapy updates: What you need to know
UnitedHealthcare·KY · Physical Therapy, Occupational Therapy·State news
We identified it
Jun 2, 2026
Summary
Kentucky Medicaid updated outpatient therapy prior authorization requirements under regulation 907 KAR 8:40. Medical necessity reviews now start at the 21st visit per discipline per calendar year, requiring initial evaluations, re-evaluations, and updated plans of care for authorization requests beyond 20 visits.
Action Required
Immediately: Billing team must ensure all outpatient PT/OT/ST requests continue using the Prior Authorization and Notification tool in UnitedHealthcare Provider Portal. For visits 21+ per discipline per calendar year, include initial evaluation, re-evaluation, and updated plan of care showing progress toward functional goals. Verify exempt diagnoses are listed in primary diagnosis field on claim forms to avoid unnecessary prior auth delays.