Notification Number: 3614
Effective date: 4/5/2018
Notification date: 1/5/2018
Topic: Florida Medicaid – Therapy treatments on the same day as evaluation
We will not reimburse for physical therapy, occupational therapy and speech-language pathology treatments when provided the same day as an evaluation service for the same discipline.
Agency for Health Care Administration (AHCA) coverage policies indicate that treatment visits are not covered when provided the same day as evaluation services.
Claim edits do not supersede the necessity to obtain preauthorization. Preauthorization requirements are still applicable. Modifiers should be used when appropriate to accurately represent the services rendered. The use of modifiers may impact Humana’s application of these edits. For additional information, consult professional coding resources.
*All edits previously posted on Humana.com/providers for fully insured commercial Humana members may be applied to self-funded members, when requested by the self-funded group.