VNS Health MLTC: Rehabilitation Therapy
Physical, occupational, and speech therapy rehab aims at improving quality of life through better mobility, function, and independence.
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How To Receive
Details on how to apply
Obtain a network provider order for evaluation and treatment by physical, occupational, and/or speech therapy.
The provider will oversee your loved one's progress.
Locate a network outpatient rehabilitation provider: Click on the Outpatient Rehabilitation (PT/ST/OT) tab on the page.
Contact the VNS Health MLTC Care Team at (888) 867-6555 (TTY 711) for prior authorization.
The VNS Health MLTC Care Team coordinates these services.
Services are covered to improve as well as maintain functional status.
There are no service limits on medically necessary PT, OT, and ST visits that are ordered by a doctor or other licensed professional.
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Rehabilitation services may be provided at outpatient locations, based on needs. These services include Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST), which are rehabilitation services provided for the purpose of maximum reduction of physical or mental disability and restoration to best functional level.
Physical therapy focuses on strength, mobility, balance, and pain. Occupational therapy focuses on function and performing activities necessary for daily living, including the use of assistive devices. Speech therapy focuses on muscles that assist with breathing, talking, chewing, and swallowing, as well as cognitive processes (thinking).
Physical Therapy is limited to forty (40) visits per calendar year. Occupational therapy is limited to twenty (20) visits per calendar year. Speech therapy is limited to twenty (20) visits per calendar year.
If receiving benefits from both Medicare and Medicaid, PT, OT, or ST visits that are paid for as part of Medicare benefits, do not count as part of the limits described above. These Medicaid limits apply to rehabilitation therapy visits that are received in a private practitioner’s office, as well as visits received in a certified hospital outpatient department or a diagnostic and treatment center (free-standing clinic).
These service limits do not apply to visits that take place in a hospital inpatient setting, in a skilled nursing facility (SNF), or by a Medicare-certified home health agency (CHHA).
Additionally, these service limits do not apply if additional services are authorized by the health plan, in the presence of a traumatic brain injury, or if determined to be developmentally disabled by the appropriate authorities (such as an Office for the Developmentally Disabled).
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