icon of two people at a table speaking to one another with a medical cross bubble between them

Autism Services: Autism PT, OT, ST and Physical Medicine

Filter:

  • All
  • Blue Cross commercial
  • Medicare Plus Blue
  • BCN commercial
  • BCN Advantage

Autism-related physical, occupational and speech therapy services and physical medicine services by athletic trainers and chiropractors

A physician must write an order or prescription for therapy.

Autism-related PT, OT and ST by therapists and physical medicine services by athletic trainers and chiropractors are subject to medical outpatient therapy deductibles, copayments or coinsurance. For other outpatient autism-related services, the primary care provider copayment and deductible apply when applicable

Prior authorization requirements vary as follows:

  • For dates of service on or after Jan. 1, 2024, prior authorization isn’t required for any member for autism-related PT, OT or ST by therapists or physical medicine services by athletic trainers or chiropractors.
  • For dates of service before Jan. 1, 2024, autism-related PT, OT and ST by therapists and physical medicine services by athletic trainers and chiropractors are managed as follows:
    • For members 19 years of age or older, EviCore by Evernorth® manages prior authorization requests. Submit requests to EviCore. See our Getting Started page for details.
    • For members under age 19, prior authorization isn’t required. Claims for these services pay without a referral or an authorization when they’re billed by a BCN-contracted provider and with a childhood autism diagnosis code (F84.0, F84.5, F84.8 or F84.9).

EviCore by Evernorth is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage authorizations for select services.