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 13, 2026
Summary
Kentucky Medicaid has updated prior authorization requirements for outpatient therapy services. Medical necessity reviews now begin at the 21st visit per discipline per calendar year, requiring submission of initial evaluation, re-evaluation, and updated plan of care through the UnitedHealthcare Provider Portal.
Action Required
Immediately: Billing team must ensure all outpatient PT/OT/ST prior authorization requests for visits 21 and beyond include initial evaluation, re-evaluation, and updated plan of care showing progress toward functional goals. Update workflow to submit these through UnitedHealthcare Provider Portal Prior Authorization tool. Ensure exempt diagnoses are listed in primary diagnosis field on claim forms to avoid unnecessary prior auth delays.