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Outpatient Rehabilitation Therapy

Primary care providers (PCPs) and designated specialists with an open referral from the PCP can refer a member for short-term rehabilitation therapies, including:

     Physical therapy
     Occupational therapy
     Speech therapy
     Habilitation Services

In most instances, the benefit for Massachusetts managed care group members is 60 visits per member per calendar year. The 60-visit maximum combines benefits for physical therapy (PT) and occupational therapy (OT) services. Speech therapy (ST) benefits are generally not included in the combined PT/OT short-term rehabilitation benefit. However, some self-funded accounts do combine the three therapies into one benefit.*

As always, it’s important for you to verify member benefits and eligibility before performing services.

*The short-term rehabilitation visit limit for Preferred Blue PPO® and Preferred Blue PPO Basic Saver® is 60 visits. The 60-day outpatient rehabilitation benefit limit does not apply to Medicare HMO Blue.