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How to bill L&I for services authorized following utilization review

The information on this site is effective July 1, 2007.

Services beyond 24 visits, need to have the 10-digit prior authorization number on the bill:

• On the CMS 1500 (F245-127-000), field 23, PRIOR AUTHORIZATION NUMBER.
• On the UB04 HCFA 1450 (F245-367-000), field 63, TREATMENT AUTHORIZATION CODES.

If there is no prior authorization, a retrospective review must be done by Qualis Health before the bill can be considered for payment.

For more information, see the Physical Medicine Services section (page 55) in L&I's Payment Policy (1,189 KB/3 min. PDF).

For more information on documenting and billing for your services:

See Physical, Occupational and Massage Therapy.