You can get Outpatient Physical and Occupational Therapies (PT/OT) at a clinic, a rehab center, or a hospital. Your provider can help you pick the best place for you to get therapy services.
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) members can get on our Benefits & Services page.
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.
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 Outpatient Physical and Occupational Therapy covered to the same extent as members who are not enrolled on a waiver program.
How many times can I get Outpatient Physical and Occupational Therapy services?
The benefit does not have a hard-annual limit for children or adults. The benefit is limited by the number of visits which are authorized.
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 on the Benefits & Services page.
You can also contact the Health First Colorado Member Contact Center for more information.
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 order or 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.
What happens if I no longer qualify for Health First Colorado or CHP+ coverage?
If you no longer qualify for Health First Colorado or CHP+, you have a limited amount of time to apply for other coverage. The time you have to apply for new coverage, known as a “special enrollment period,” changes depending on the coverage provider.
Other health coverage options include:
- Coverage through your employer. Check with your employer to learn about options, rules and deadlines.
- Coverage through a family member’s health insurance, such as a spouse, or parent if you are 25 or younger
- Coverage through Connect for Health Colorado (Colorado’s official health insurance marketplace). You might qualify for financial assistance to reduce the cost of your premium.
- To get free help enrolling in Connect for Health Colorado coverage, reach out to a certified assister online or by calling 855-752-6749. TTY: 855-346-3432
- Coverage through Medicare for people age 65 or older or people under 65 with certain disabilities or end-stage renal disease. If you need help finding a plan, contact the Colorado State Health Insurance assistance Program (Colorado SHIP, a Medicare assistance program) at 888-696-7213.
- Coverage for active or former military, naval, or air service through Tricare (active) or VA (veterans).
If you no longer qualify because you missed the deadline to respond, you can reapply for Health First Colorado. To get free help filling out an application for Health First Colorado or CHP+ coverage, or to learn about other coverage options, call and make an appointment at a certified application assistance site.
How can I get my prescription by mail?
1. Check with your pharmacy: Ask your current pharmacy if they provide mail delivery for your prescriptions.
2. If your current pharmacy does not offer mail delivery, and you want to stay local:
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- Search for nearby pharmacies using the Find a Doctor tool.
- Enter your address in the “Find Providers Near Me” field, or click the “Find Me” button to see your location.
- Adjust the “Within” tool to set how far you are willing to travel.
- Select “Pharmacy” from the “Find Providers by Type” dropdown list.
- Call nearby pharmacies to ask about their delivery options.
3. If no local pharmacies offer mail delivery:
- Search for mail order pharmacies using the Find a Doctor tool.
- Select “Pharmacy” from the dropdown list.
- Zoom out using the “-” button on the map to find other areas or out-of-state pharmacies that might offer mail order services.
- If you choose mail order services, you can get new or refill prescriptions for chronic conditions in a supply of up to 100 days. These are called maintenance medications, which are taken regularly to manage a wide range of ongoing or long-term conditions and illnesses.
Important
Health First Colorado does not keep an official list of pharmacies that offer mail delivery. We recommend that you call pharmacies directly and ask if they can meet your specific medication needs.
Questions?
If you need more information, call the Pharmacy Liaison at 303-866-3588.
My pharmacy told me my medication is denied because a prior authorization was needed. What should I do?
Some medications require your doctor to file a prior authorization request before a medication will be covered. Please ask your doctor to contact Health First Colorado (Colorado’s Medicaid program) at 1-800-424-5725 to request a prior authorization for your medication. Once the prior authorization is submitted, it will take up to 24 hours to process.
My pharmacy told me my diabetic supplies are not covered. Is that true?
Diabetic supplies such as test strips, lancets and syringes are a covered medical benefit and not a pharmacy benefit. Please ask the pharmacy to bill DME-Supplies. Pharmacies can call 1-800-237-0757 if they require additional assistance billing supplies.