UT CODE/BENEFIT EXCEPTIONS

  • ST:
    Traditional Medicaid: After initial evaluation plus six (6) visits for office and outpatient settings. Prior authorization approval required for therapy visits beyond the stated limits.
    • EPSDT eligible members from the ages of 2-20 are allowed one individual session per week for six months or less as designated in the plan of care unless the medical need for more services is documented. Adult pregnant members are allowed 15 annual visits.
    Non-Traditional: Non-Covered benefit.
    MKPL: 20 visits for PT/OT/ST combined per calendar year (benefit limit).
  • OT & PT
    Traditional Medicaid: After initial evaluation plus twenty (20) visits per calendar year for office and outpatient settings for each specialty. Prior authorization approval required for therapy visits beyond the stated limits.Non-traditional Medicaid allows 16 combined therapy visits yearly in any arrangement, e.g., all PT, all OT, or mixed.
    MKPL: Twenty (20) visits for PT/OT/ST combined per calendar year (benefit limit).