Clarification on Regence Prior Authorization for Physical Medicine Codes

In a teleconference with Dr. Mary Kay O’Neill, the new Regence Executive Medical Director for Washington, Oregon, Idaho and Utah, Kavin Williams, AOA Senior Manager of Public and Private Payment Advocacy, and WOMA Executive Director Kathie Itter, Regence confirmed that OMT codes 98925-98929 are not included in the Regence physical medicine prior authorization program.

The program is scheduled to be launched November 1, 2013. However, if any of the listed modalities, including physical therapy, are provided, DOs will need to report it to the system administered by CareCore National, LLC (CCN). For most DOs, this will require a Tier 1 notification which means the provider is required to notify CCN within seven days of providing the treatment, but will not have to wait for prior authorization to provide it. (Some staff of osteopathic physicians were incorrectly told by Regence provider relations personnel that the physical medicine prior authorization program included osteopathic manipulation).