Pre Treatment Authorization

60 Day Presumptive Approval — for a period not to exceed 60 days following the date of injury, Provider's have presumptive approval for providing the following services when treating soft tissue and musculoskeletal injuries for the allowed conditions in allowed claims:

  • Ten (10) physical medicine visits including Osteopathic, Chiropractic, Physical therapy & Occupational therapy
  • Diagnostic studies, including x-rays, CAT scans, MRI scans and EMG/NCV
  • Injections up to three soft tissue or joint injections (does not include epidural injections)
  • E/M services and consultation services

NOTE: The following criteria must be met prior to initiating any or all of the aforementioned services for the 60 day presumptive approval to be valid:

1. The Provider shall file the First Report of Injury (FROI) with the MCO
2. The Provider shall complete and file the C-9 Treatment Plan with the MCO
3. The Provider shall notify the MCO within 24 hours of treatment if the injured worker will be off work for more than 2 calendar days

Additional Information:

HMS Prior Authorization Table

HMS Home