Physical and Occupational Therapy Codes requiring PA for Medicare Members effective 1/1/26
Effective January 1, 2026, in partnership with eviCore, BCBSRI will be expanding eviCore’s authorization management to include Physical and Occupational therapy waiver program for our Medicare Advantage population only. BCBSRI will continue to manage all appeals. Authorization requests for Prospect members will continue to go through Prospect via fax.
Notification will be required for physical therapy services and occupational therapy services for visits 1-14 per episode of care. Prior authorization will be required for physical therapy services and occupational therapy services occurring after the 14th visit per episode of care.
All Physical and Occupational Therapy codes that will require an authorization through eviCore effective January 1, 2026, can be in the Medical Policy “Prior Authorization of Physical and Occupational Therapy Services”.
eviCore will hold four educational webinars in December. Participants will learn how to obtain authorizations through the eviCore website and authorization timeframes.
To register for one of the webinars, please follow the instructions below:
1. Go to http://eviCore.webex.com/
2. Click the Upcoming tab.
3. Choose – BCBSRI PT/OT Training. You can find this easily by using the search bar.
4. Click "Register" next to the session you wish to attend.
5. Enter the required registration information. Click the Register button.
If you are unable to participate in a session, you can view the provider orientation presentation on the BCBSRI resources page located on eviCore.com or by using this URL https://www.evicore.com/resources/healthplan/blue-cross-blue-shield/rhode-island.
After you have registered, you will receive an e-mail containing the toll-free phone number, meeting number, conference password, and a link to the web portion of the session. Please retain the registration e-mail so you will have the link to the web conference and the call-in number for the session in which you will be participating.
If you have any questions regarding the eviCore web portal, please contact the Web Support team via email at portal.support@evicore.com or via phone at 800.646.0418 (Option 2). For any or provider inquiries not associated with this training, please email ClientServices@evicore.com
If you have any additional questions about these changes or webinar registration, please contact Provider Relations at 1-844-707-5627 or ProviderRelations@bcbsri.org.