UR Trigger List

Examiner May Authorize Without Sending to UR

PT and Chiro

  • Initial Physical Therapy, Chiro Visits, Osteopathic Manipulation up to 6 visits

DME

  • Cane, Braces, Walkers, Walking Boot, and DME under $500

Diagnostics

  • X-Rays, MRI’s (except Cervical), EMGs,
    • Per most guidelines, DX should not be authorized until objective findings are compatible such as numbness tingling, ongoing spasm for 90 days
    • Per Trigger List, Post 6 Months Examiner is to discuss with Superior to determine if we should authorize or send to UR.

Medications

  • Ibuprofen (Motrin), acetaminophen (Tylenol), Aspirin, Vitamins (such as C), Antibiotics (Azithromycin), Baclofen
  • Items listed on the Non-Exempt List for court of less than 30 days, See attached

Per Case Law, you can NOT send a medication or treatment plan that has been On-Going, Ordered by a Judge or Stipulated to by the Parties to through UR.

 

Examiners Should Send to UR.  These have potential high  exposure or may not be considered reasonable