Health First Colorado Outpatient Physical and Occupational Therapy Benefits Frequently Asked Questions
- Do I need a referral or a provider’s permission to get Outpatient Physical and Occupational Therapy (PT/OT)?
Yes. Your primary care doctor, or the hospital you are discharged from, may refer you to a physical or occupational therapist to help you recover. You may also go directly to a therapist for care, but that therapist must contact your primary care doctor to get approval for your treatment plan.
Children ages 0 to 3 may receive Outpatient Physical and Occupational Therapy (PT/OT) without a referral if it is coordinated through Early Intervention Colorado.
- How do I keep track of the number of Outpatient Physical and Occupational Therapy (PT/OT) hours I have?
At this time, Health First Colorado (Colorado’s Medicaid Program) members are responsible for tracking the number of therapy hours they have. Your provider will be able help you keep track.
- How many times can I get Outpatient Physical and Occupational Therapy services?
The number of Outpatient Physical and Occupational Therapy (PT/OT) services you can get depends on your age.
- Children (ages 0 through 20) do not have a limit to the number PT/OT services they can get in 12 months.
- Adults (ages 21 and over) are limited to 12 hours of Rehabilitative therapy in 12 months. Some adults have an additional 12 hours of Habilitative therapy in 12 months
Your provider will be able to help answer your questions about PT/OT services and how many you are able to get in 12 months.
You can read about the PT/OT services a Health First Colorado (Colorado’s Medicaid Program) member can get in our Benefit Coverage Standard or on the Benefits & Services page.
You can also contact the Health First Colorado Member Contact Center for more information.
- I receive Health First Colorado services through a waiver program. How many Outpatient Physical and Occupational Therapy (PT/OT) hours do I get?
Health First Colorado (Colorado’s Medicaid Program) members who get services through a waiver program have the same number of Outpatient Physical and Occupational Therapy (PT/OT) hours. Waiver services do not include extra PT/OT services.
- What is Outpatient Physical and Occupational Therapy?
Physical and Occupational Therapies (PT/OT) are services meant to help you recover from an acute injury, illness, or surgery. Some therapies are meant to help you maintain physical ability, or help children reach developmental milestones.
PT/OT is performed by licensed professionals. Health First Colorado (Colorado’s Medicaid Program) limits the number of PT/OT services you can get in a year. Get more information on PT/OT limits.
- Where can I find more information about Outpatient Physical and Occupational Therapy (PT/OT) services?
Your provider will be able to help answer questions about your Outpatient Physical and Occupational Therapy (PT/OT) services.
You can read about the PT/OT services Health First Colorado (Colorado’s Medicaid Program) member can get in our Benefit Coverage Standard or on our Benefits & Services page.
- Where can I get Outpatient Physical and Occupational Therapy services?
You can get Outpatient Physical and Occupational Therapies (PT/OT) at a clinic, a rehab center, a hospital when you are not admitted overnight, and other places. Your provider can help you pick the best place for you to get PT/OT services.
Outpatient PT/OT is not provided:
- during an inpatient hospital stay,
- when it is coordinated by a Home Health Agency, or
- when it is performed in the school setting.
You can still get PT/OT services in these three settings but it will not count against the number of Outpatient PT/OT services you can get in a year.
