NY State Medicaid (FFS) Outpatient Physical Therapy prior authorization requirements (2026)
What NY State Medicaid (FFS) 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. Based on the cited policy, NY State Medicaid (FFS) 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 NY State Medicaid (FFS), as this can vary by plan.
Medical-necessity criteria NY State Medicaid (FFS) generally applies
New York State Medicaid fee-for-service no longer requires prior authorization for medically necessary physical therapy visits (effective July 1, 2024), and visit limits were removed (effective 2021). Therapy must still be medically necessary and supported by a skilled plan of care with measurable functional goals; documentation should establish the need for skilled therapy. Managed-care/MCO members follow their plan rules, which may still require authorization.
Source
Source: New York State Medicaid Update, May 2024 (Vol. 40, No. 5), health.ny.gov; eMedNY Rehabilitation Services Manual. Last verified 2026-06-11.
Frequently asked questions
Does NY State Medicaid (FFS) require prior authorization for Outpatient Physical Therapy?
Based on the cited policy, NY State Medicaid (FFS) 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 NY State Medicaid (FFS), as this can vary by plan.
What does NY State Medicaid (FFS) require to approve Outpatient Physical Therapy?
New York State Medicaid fee-for-service no longer requires prior authorization for medically necessary physical therapy visits (effective July 1, 2024), and visit limits were removed (effective 2021). Therapy must still be medically necessary and supported by a skilled plan of care with measurable functional goals; documentation should establish the need for skilled therapy. Managed-care/MCO membe… Always confirm against the current NY State Medicaid (FFS) policy.
How long does a NY State Medicaid (FFS) prior authorization take?
Turnaround varies by plan and submission method. Check the NY State Medicaid (FFS) portal for current timeframes.
Submitting Outpatient Physical Therapy to NY State Medicaid (FFS)?
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.