Allstate Outpatient Physical Therapy prior authorization requirements (2026)
What Allstate generally requires to approve Outpatient Physical Therapy (CPT 97161, 97162, 97163, 97164, 97110, 97112, 97113, 97116, 97124, 97140, 97150, 97530, 97535, 97542, 97750, 97760, 97761, 97010, 97012, 97014, 97032, 97035), for Auto No-Fault (MI PIP) plans. Based on the cited policy, Allstate does not generally require prior authorization for Outpatient Physical Therapy (CPT 97161, 97162, 97163, 97164, 97110, 97112, 97113, 97116, 97124, 97140, 97150, 97530, 97535, 97542, 97750, 97760, 97761, 97010, 97012, 97014, 97032, 97035). Confirm with Allstate, as this can vary by plan.
Medical-necessity criteria Allstate generally applies
Michigan auto no-fault imposes NO statutory pre-authorization for outpatient PT. Coverage turns on the reasonable-necessity standard of MCL 500.3107(1)(a) (products, services and accommodations reasonably necessary for the injured person's care, recovery, or rehabilitation). In place of precertification, every PIP insurer operates a DIFS-certified UTILIZATION REVIEW program (MCL 500.3157a; Mich Admin Code R 500.61-500.69) that retrospectively evaluates treatment against "medically accepted standards" (the most appropriate practice guidelines - generally accepted, evidence-based, or federal/professional-society guidelines). If PT is longer, more frequent, or extends over more days than usually required for the diagnosis, the insurer may require a written explanation of necessity: the insurer must request it within 30 days of receiving the disputed bill, the provider must respond within 30 days, and the insurer must issue a written determination within 30 days of the response, stating the criteria relied on and including the DIFS appeal form. The provider may appeal a UR determination to DIFS within 90 days on form FIS 2356 (DIFS-URAppeals@michigan.gov); the DIFS Director decides on the written record within 28 days (one extension allowed), with interest on overdue payments under MCL 500.3142. Reimbursement is capped by MCL 500.3157: generally 190% of the Medicare amount for services after 7/1/2023 (52.5% of the provider's charge master where no Medicare amount exists). Document the accident date, causation, and objective functional progress throughout; retain UR records at least two years (R 500.69).
Commonly required documentation
- Prescription/order where applicable
- evaluation and plan of care tying treatment to the auto injury (accident date, causation)
- objective functional measures and progress notes
- itemized bills
- written explanation of necessity within 30 days if the insurer requests one under UR.
How to submit
- Method: Bill the PIP insurer directly; respond to UR record requests in writing; DIFS appeal via form FIS 2356
- Typical turnaround: about 30 days
Sources & verification
MI PIP (auto no-fault) - statewide statute/DIFS rules, identical for every MI PIP insurer. Sources: MCL 500.3157a MCL 500.3157 (fee cap); DIFS UR Rules https://www.michigan.gov/-/media/Project/Websites/difs/ORRA/Utilization_Review_Rules.pdf; FIS 2356 https://www.michigan.gov/-/media/Project/Websites/difs/Form/Insurance/UR/FIS_2356.pdf; provider guide FIS-PUB 8520. Verified 2026-07-09. Distinct from this carrier's NJ PIP rows (NJ has Decision Point Review/precert; Michigan does not). [NEEDS CLINICAL SPOT-CHECK] View the source policy. Last verified 2026-07-09.
Frequently asked questions
Does Allstate require prior authorization for Outpatient Physical Therapy?
Based on the cited policy, Allstate does not generally require prior authorization for Outpatient Physical Therapy (CPT 97161, 97162, 97163, 97164, 97110, 97112, 97113, 97116, 97124, 97140, 97150, 97530, 97535, 97542, 97750, 97760, 97761, 97010, 97012, 97014, 97032, 97035). Confirm with Allstate, as this can vary by plan.
What does Allstate require to approve Outpatient Physical Therapy?
Michigan auto no-fault imposes NO statutory pre-authorization for outpatient PT. Coverage turns on the reasonable-necessity standard of MCL 500.3107(1)(a) (products, services and accommodations reasonably necessary for the injured person's care, recovery, or rehabilitation). In place of precertification, every PIP insurer operates a DIFS-certified UTILIZATION REVIEW program (MCL 500.3157a; Mich Ad… Always confirm against the current Allstate policy.
How long does a Allstate prior authorization take?
Allstate typically decides Outpatient Physical Therapy requests in about 30 days. Timeframes vary; check the payer portal.
Submitting Outpatient Physical Therapy to Allstate?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.