Therapy - Occupational/Physical/Speech

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Required Forms for All Therapy

  • HCA-61
  • SC-15 English | Spanish - Parental Consent Form or provider-generated Parental Consent Form (if utilizing a provider generated form it must include all information contained on the SC-15 form)
  • SC-16 English | Spanish - Change of Provider Form (if applicable)

 


 

Guidelines for Speech Services 

 

Guidelines for Occupational and Physical Therapy Services

In an effort to expedite prior authorizations for initial post-operative and acute injuries, we allow the use of an SC modifier for Occupational and Physical Therapy requests. Please see Provider Letter 2012-09 for Guidance on the appropriate use of this modifier