Samaritan Health Plans has revised the approval process for acupuncture treatments for back pain. This change is following the Oregon Health Plan published Guideline 56 from 2018 to assist members with back issues. Providers are now required to use a validated risk assessment tool, such as the STarT Back Assessment Tool, to provide documentation that supports the efficacy of and need for continuing treatment. Treatment options include acupuncture, massage, and chiropractic care in addition to PT, OT and OMT.
A total of 30 visits per calendar year of a combination of these therapies is available to members who are considered Medium to High risk on a validated risk assessment tool. For members who are considered Low risk, up to 4 total visits of these treatment modalities will be approved. Prior authorization requests that arrive without a validated risk assessment will be authorized for a limited number of visits until more documentation is received.
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