Section 17b-262-626 - Prior authorization(a) To receive payment from the department, a podiatrist shall comply with the prior authorization requirements described in section 17b-262-528 of the Regulations of Connecticut State Agencies. The department, in its sole discretion, shall determine what information is necessary in order to approve a prior authorization request. Prior authorization does not, however, guarantee payment unless all other requirements for payment are met.(b) Prior authorization, on forms and in the manner specified by the department, shall be required for: (1) physical therapy services in excess of two visits per calendar week per client per podiatrist;(2) physical therapy services in excess of nine visits per calendar year per client per podiatrist, when the therapy is for the treatment of the following diagnoses: (A) cases involving musculoskeletal system disorders of the spine covered by the ICD, as amended from time to time; and(B) cases involving symptoms related to nutrition, metabolism and development covered by the ICD, as amended from time to time;(3) reconstructive surgery;(5) EPSDT services that are identified during a periodic screening as medically necessary and which are not listed on the existing fee schedule; and(6) other services and supplies identified as requiring prior authorization on the fee schedule.(c) Prior authorization is required for payment of all hospital admissions as required and described in section 17-134d-80 of the Regulations of Connecticut State Agencies.(d) The authorization period shall be for a period not to exceed six months.(e) If prior authorization is needed beyond the initial authorization period, requests for continued treatment beyond the initial authorization period shall be considered for up to an additional six month period per request.(f) Except in emergency situations, prior authorization shall be received before services are rendered.(g) In an emergency situation that occurs after working hours or on a weekend or holiday, the podiatrist shall secure verbal prior authorization on the next working day for the services provided. This applies only to those services that normally require prior authorization.Conn. Agencies Regs. § 17b-262-626
Adopted effective February 11, 2009