HAP (Health Alliance Plan) Outpatient Physical Therapy prior authorization requirements (2026)
What HAP (Health Alliance Plan) 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 Commercial plans. Based on the cited policy, HAP (Health Alliance Plan) 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 HAP (Health Alliance Plan), as this can vary by plan.
Medical-necessity criteria HAP (Health Alliance Plan) generally applies
Outpatient PT is not among the services HAP publicly lists as requiring prior authorization (published examples: MRI/CT, DME, growth hormone, home care, inpatient, ambulance, select outpatient procedures, transplants, specialty drugs, genetic testing), and eviCore's HAP scope covers radiology, MSK procedures/pain management, and sleep - not therapy visits. HAP HMO plans are referral-based; a physician order is required and rehabilitative/habilitative therapy benefit limits apply (e.g., 60 combined PT/OT/ST visits per benefit period on the published federal plan). IMPORTANT: HAP's full commercial prior-authorization list sits behind the hap.org provider login and could not be publicly verified - confirm for the member's specific group before treating. Separately, members of the UAW-Ford and Stellantis-UAW groups have their outpatient PT benefit carved out to TheraMatrix (a Michigan PT network TPA): for those members, PT authorization and claims go to TheraMatrix, not the medical carrier (current contract status not independently verified).
Commonly required documentation
- Physician order/referral per plan
- verify the member's group PA list and therapy visit limits via the hap.org provider portal before an extended course
- for UAW-Ford/Stellantis members confirm whether TheraMatrix administers the PT benefit.
How to submit
- Method: hap.org provider portal (Authorizations); non-contracted providers: RMT@hap.org
- Portal: HAP provider portal
Sources & verification
Sources: 2026 OPM brochure https://www.evicore.com/resources/healthplan/hap; https://theramatrix.com/ (UAW-Ford carve-out eff. 8/1/2005). UNVERIFIED: full commercial PA list (behind login); whether any HAP product uses WholeHealth Networks for therapy; current TheraMatrix contract status. [NEEDS CLINICAL SPOT-CHECK] View the source policy. Last verified 2026-07-09.
Frequently asked questions
Does HAP (Health Alliance Plan) require prior authorization for Outpatient Physical Therapy?
Based on the cited policy, HAP (Health Alliance Plan) 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 HAP (Health Alliance Plan), as this can vary by plan.
What does HAP (Health Alliance Plan) require to approve Outpatient Physical Therapy?
Outpatient PT is not among the services HAP publicly lists as requiring prior authorization (published examples: MRI/CT, DME, growth hormone, home care, inpatient, ambulance, select outpatient procedures, transplants, specialty drugs, genetic testing), and eviCore's HAP scope covers radiology, MSK procedures/pain management, and sleep - not therapy visits. HAP HMO plans are referral-based; a physi… Always confirm against the current HAP (Health Alliance Plan) policy.
How long does a HAP (Health Alliance Plan) prior authorization take?
Turnaround varies by plan and submission method. Check the HAP (Health Alliance Plan) portal for current timeframes.
Submitting Outpatient Physical Therapy to HAP (Health Alliance Plan)?
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.