Authorizations, ListServ Summary, Jan 2026
Rehab administrators answer questions regarding Insurance authorizations. IPRC archives information collected by the Pediatric Rehab Administrator’s ListServ as a public service to the entire Pediatric Rehabilitation Community. All information is posted in summary format and has been de-identified. Search through past queries for responses to rehabilitation related questions.
Original Questions:
- For patients who are receiving on-going services (defined as 6 months or greater without a break), do you require a re-evaluation at a specific time period?
- If so, how frequently and what determines this?
- Are you billing this as an evaluation or re-evaluation? (realizing that Speech does not have a re-eval CPT Code How do you navigate differences in insurance coverage related to the number of evaluations/re-evaluations allowed in a 12 month time period?
- When using an Episode of Care model: Do you discharge the patient at the end of each EOC? If/when they return, do you schedule/bill this as an evaluation or re-evaluation?
- How do you navigate this if an insurance company allows only one evaluation per year?
Summary of Responses (de-identified)
