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CO HCPF Physical and Occupational Therapy Billing Manual — Benefit Limitations
BenefitLimitations
ProvidersarerequiredtoconsulttheAmericanMedicalAssociation's(AMA)CurrentProceduralTerminology(CPT)manualforeachcodedservice.Somecodesrepresentatreatmentsessionwithoutregardtoitslengthoftime(one[1]unitmaximum)whileothercodesmaybebilledincrementallyas"timed"units.
Membersmayreceiveupto48unitsofanycombinationofPT/OTservicesperrolling12-monthperiodbeforeaPriorAuthorizationRequest(PAR)isrequired.Evaluationandorthoticservicesarenotincludedinthislimit.Thisequatestoroughly12hoursoftherapyservices(eachunitofservicebeingequalto15minutes).Thisunitlimitwillbeautomaticallyenforcedbytheclaimspaymentsystembydenyingclaimsthatexceedthelimit.
Unitsofserviceexceedingtheinitial48unitsarenotcoveredwithoutanapprovedPAR.
The12-monthperiodbeginswhentherapyisinitiated.Theunitlimitdoesnotroll-overtoaccumulatemorethan48availableunitsina12-monthperiod.Unitsarecontinuallyavailableuntilthelimitof48hasbeenreachedina12-monthperiod.
Unitsdecrementfrompaidunitsforaspecificmember,regardlessoftheprovider,beginonthefirstdateofservice.Aunitequalseither1)atimedincrementor2)one(1)treatmentsessionasdescribedinthespecificCPTprocedurecodes.
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
6089e4c57fd90575f77a87ba5e9c16af76335c364d4cb151976250aefc5ccb38
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