Effective September 15, 2026: Prior Authorization Requirement Update for PT, OT and SLP Services for CareFirst BlueCross BlueShield Medicare Advantage

Posted on 2026-07-15 | Updated on 2026-07-16 10:13:54

Beginning September 15, 2026, CareFirst BlueCross BlueShield Medicare Advantage plans (CareFirst BlueCross BlueShield Advantage Essential (PPO), Complete (PPO), Salute (PPO), and CareFirst BlueCross BlueShield Group Advantage (PPO) plans will require prior authorization for physical therapy (PT), occupational therapy (OT) and speech-language pathology (SLP) services starting with the first visit.

This change applies to these members receiving PT, OT or SLP services with dates of service on or after September 15, 2026. Providers should confirm member eligibility and benefits before rendering services and verify prior authorization requirements through the Prior Authorization Lookup Tool available within the CareFirst Provider Portal (CareFirst Direct).

Important Reminders

  • Providers should submit prior authorization requests before services are rendered.
  • Prior authorization approvals are based on medical necessity, appropriateness and covered benefits, and are not a guarantee of payment.

How to Submit Requests

Participating providers should submit prior authorization requests electronically through the CareFirst Provider Portal (CareFirst Direct). The portal allows providers to verify requirements, submit requests, upload supporting clinical documentation and check authorization status electronically.

  1. Log into the CareFirst Provider Portal (CareFirst Direct).
    Provider portal navigation.
  2. Navigate to the ‘Prior Authorizations’ tile on the home page or select the ‘Prior Auth/Notifications’
    Prior Auth/Notifications tab and Prior Authorizations tile.
  3. To verify prior authorization requirements, you can utilize the Prior Authorization Lookup (PAL) tool by selecting ‘Verify Requirements’. If prior authorization is required, the tool will transfer you to the appropriate prior authorization system to enter your request.
    Prior Authorization Lookup (PAL) tool.
  4. If you already know prior authorization is required, select ‘Start’ within the ‘Medical’ tile to enter your request.
    Start button on medical tile.

When submitting a request, include all required clinical documentation to support the medical necessity of the services requested.

If you have questions or need additional support, please access the Provider Support Tool.

Thank you for your continued partnership in delivering quality care to our members.