MVP Health Care Outpatient Physical Therapy prior authorization requirements (2026)
What MVP Health Care 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. Yes. MVP Health Care 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 MVP Health Care generally applies
Outpatient physical therapy and musculoskeletal services are reviewed for medical necessity through MVP and its partner Magellan/NIA Healthcare. Prior authorization is required for designated outpatient therapy and musculoskeletal services; MVP reviews the member condition and the requested services for medical necessity. Continued therapy is supported by a skilled plan of care with measurable functional goals and documented progress, or maintenance therapy to prevent decline where covered. Verify the member plan and the current MVP UM Policy Guide and Magellan/NIA guideline.
Source
Source: MVP Health Care Utilization Management Policy Guide (New York State) and the Magellan/NIA musculoskeletal program (mvphealthcare.com). Last verified 2026-06-11.
Frequently asked questions
Does MVP Health Care require prior authorization for Outpatient Physical Therapy?
Yes. MVP Health Care 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 MVP Health Care require to approve Outpatient Physical Therapy?
Outpatient physical therapy and musculoskeletal services are reviewed for medical necessity through MVP and its partner Magellan/NIA Healthcare. Prior authorization is required for designated outpatient therapy and musculoskeletal services; MVP reviews the member condition and the requested services for medical necessity. Continued therapy is supported by a skilled plan of care with measurable fun… Always confirm against the current MVP Health Care policy.
How long does a MVP Health Care prior authorization take?
Turnaround varies by plan and submission method. Check the MVP Health Care portal for current timeframes.
Submitting Outpatient Physical Therapy to MVP Health Care?
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.