Important Outpatient Therapy and Home Health Prior Authorization Entry Guidelines
To ensure a smooth process for your prior authorization requests and subsequent claims submissions, we are providing specific guidance for entering prior authorizations for outpatient therapies and home health.
Effective October 27, 2025, the following guidelines must be followed when
submitting your requests:
- Submit all modality codes for treatment that require prior authorization per the
Prior Authorization Lookup Tool, and the number of visits being requested for each.- For example, if you are submitting a request for Physical Therapy, include all
the codes you are requesting on the prior authorization (e.g., 97110, 97112,
97115, etc., for 12 visits/units). - The codes submitted on your claim that require prior authorization should
match the codes you included on your prior authorization request. - Reminder: CareFirst does not review codes that do not require prior authorization.
- For example, if you are submitting a request for Physical Therapy, include all
- Only submit the total number of appropriate visits/units for the episode of
care, as these will be reviewed against MCG to determine medical necessity.
Enter your Prior Authorizations Electronically Through the CareFirst Provider Portal
- Access the Entering Prior Authorizations through the CareFirst Provider Portal course for step-by-step instructions.
Benefits of Entering Prior Authorizations through the CareFirst Provider Portal
- Eliminates the need to fax your requests
- Access to the Prior Authorization Lookup Tool to quickly verify requirements
- Quicker review and decisioning by the Utilization Management team
- Ability to see the status of your requests
- Ability to edit dates of service on open authorizations
- Ability to easily upload any needed clinical documentation directly to your request
- Ability to view and respond to messages from CareFirst regarding the
authorizations you submitted
Need additional support?
Access this brief tutorial that walks you through the process for these types of requestof request