Examiner May Authorize Without Sending to UR
PT and Chiro
- Initial Physical Therapy, Chiro Visits, Osteopathic Manipulation up to 6 visits
- Cane, Braces, Walkers, Walking Boot, and DME under $500
- 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.
- 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