November 21, 2019
Beginning January 1, 2020, eviCore Healthcare will no longer review physical therapy, occupational therapy and massage therapy services for individual plans. Evolent Health will start reviewing these services for dates of service February 21, 2020 and after using InterQual® criteria (see policy 10.01.530 Services Reviewed Using InterQual® Criteria) for physical therapy and occupational therapy services. A new medical policy has been developed for massage therapy which applies only to individual plans (see policy 8.03.506 Massage Therapy). Please refer to the code list for specific review requirements related to each service.