Meridian Outpatient Physical Therapy prior authorization requirements (2026)
What Meridian 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 Medicaid plans. Yes. Meridian generally requires 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).
Medical-necessity criteria Meridian generally applies
Prior authorization required: Meridian (Michigan Medicaid MCO) routes outpatient PT/OT authorization through Evolent (formerly NIA) - verify and submit via RadMD (www1.radmd.com). Common PT CPT codes (97110, 97112, 97116, 97140, 97530, etc.) appear on Meridian's prior-auth requirements list. Effective 5/1/2025, out-of-network providers need authorization for ALL services. FQHC/RHC services are exempt.
Commonly required documentation
- Evaluation with objective findings, treatment plan with frequency/duration and measurable functional goals, progress documentation for continued-care requests, submitted via RadMD.
How to submit
- Method: Evolent via RadMD (www1.radmd.com)
- Portal: Evolent / RadMD
Sources & verification
Sources: PA requirements list (12/31/2025 version) https://www.mimeridian.com/providers/preauth-check/medicaid-pre-auth/022026-prior-auth-requirements.html. UNVERIFIED detail: search snippets suggest PT by chiropractic-specialty providers and telehealth PT may fall outside Evolent management - could not confirm on a durable Meridian page. [NEEDS CLINICAL SPOT-CHECK] View the source policy. Last verified 2026-07-09.
Frequently asked questions
Does Meridian require prior authorization for Outpatient Physical Therapy?
Yes. Meridian generally requires 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).
What does Meridian require to approve Outpatient Physical Therapy?
Prior authorization required: Meridian (Michigan Medicaid MCO) routes outpatient PT/OT authorization through Evolent (formerly NIA) - verify and submit via RadMD (www1.radmd.com). Common PT CPT codes (97110, 97112, 97116, 97140, 97530, etc.) appear on Meridian's prior-auth requirements list. Effective 5/1/2025, out-of-network providers need authorization for ALL services. FQHC/RHC services are exe… Always confirm against the current Meridian policy.
How long does a Meridian prior authorization take?
Turnaround varies by plan and submission method. Check the Meridian portal for current timeframes.
Submitting Outpatient Physical Therapy to Meridian?
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.