Therapy Services

Therapy Services

Cardiac Rehabilitation – Outpatient

Benefits for outpatient cardiac rehabilitation are provided if there is a clear medical need and the attending provider has given a referral. Prior approval must be obtained from BCBSMS. The attending provider must submit a formal treatment plan to BCBSMS, which includes the number of visits, the duration of therapy, and the expected outcomes. Maintenance or exercise therapy is not covered.

Participants must use a cardiac rehabilitation program that is certified by the American Association of Cardiovascular and Pulmonary Rehabilitation. To locate a certified provider, contact BCBSMS at the telephone number listed in the front inside cover of this Plan Document.

Chiropractic Services

Manipulative chiropractic therapy services are limited to a maximum of 30 visits per participant per calendar year.

Occupational Therapy

Occupational therapy services are covered when prescribed by the participant's provider and specified in a treatment plan. BCBSMS may require proof of medical necessity. Services must be provided by a licensed occupational therapist.

Physical Therapy

Physical therapy services are covered when prescribed by the participant's provider and specified in a treatment plan. BCBSMS may require proof of medical necessity.

Pulmonary Rehabilitation Programs

Benefits are provided for medically necessary pulmonary rehabilitation programs.

Speech Therapy

Speech therapy services are covered if needed due to an illness or injury. There must be a reasonable expectation that the therapy will achieve measurable improvement within a reasonable and predictable period. Services must be prescribed by a provider and performed by a licensed speech therapist.

Speech therapy services for delayed language development are limited to a lifetime maximum of 15 visits. Speech therapy is not covered for maintenance speech, articulation disorders, learning disabilities, attention disorders, psychosocial speech delay, behavioral problems, conceptual handicap, mental retardation, stammering or stuttering.