Things You Should Know This Week 7/14/2026

Written By Bryanne Halfhill

Aetna Removes Physician Signature Requirement for Occupational Therapy Plans of Care

Aetna has officially eliminated its requirement for physician signatures on Occupational Therapy plans of care, recognizing the autonomy of occupational therapists practicing within their scope.

Occupational therapists may now:

  • Complete evaluations

  • Establish plans of care

  • Initiate treatment without obtaining a physician signature solely to satisfy Aetna policy.

American Specialty Health Clinical Performance System Visit Bank Reset

Effective July 1, American Specialty Health reset its annual Clinical Performance System (CPS) visit allowances for participating providers.

Each provider's available visits before medical review depends on their current CPS tier, which may have changed with the new plan year.

Action Items

  • Verify your current CPS tier within ASHLink.

  • Update scheduling and authorization workflows with the new visit allowances.

  • Continue monitoring visit utilization to ensure medical necessity reviews are submitted promptly once visit thresholds are reached.

A quick review of your CPS status now can prevent unnecessary authorization delays and treatment interruptions later in the year.

Commercial Payers Increase Automated Reviews of RTM CPT Codes

Many commercial insurers and regional Blue Cross Blue Shield plans updated automated claim-editing logic effective July 1, 2026.

Practices utilizing Remote Therapeutic Monitoring (RTM) should review their billing processes carefully.

Codes receiving additional scrutiny include:

  • 98979

  • 98984

  • 98985

Because these are considered "sometimes therapy" services depending on clinical circumstances, missing therapy modifiers can significantly impact reimbursement.

UnitedHealthcare Reduces Prior Authorization Requirements

UnitedHealthcare has begun implementing its initiative to eliminate prior authorization requirements for approximately 30% of utilization management services, including select outpatient therapy services.

Although fewer services require prior authorization, documentation requirements have not changed. UHC has indicated it will continue focusing on retrospective post-payment audits.

Your documentation should continue to clearly support:

  • Skilled medical necessity

  • Functional limitations

  • Objective measurements

  • Measurable treatment goals

  • Ongoing progress toward functional improvement

Mid-Year Progress Check: Monitor the 2026 Medicare KX Modifier Thresholds

As we pass the halfway point of the year, many Medicare patients are approaching the annual therapy threshold. Now is the time to ensure your clinicians and billing team are actively monitoring cumulative therapy spend.



The Threshold

  • $2,480 for Physical Therapy and Speech-Language Pathology services combined and $2,480 for Occupational Therapy.

The Rule

  • Once a patient's accrued therapy expenses exceed $2,480, every subsequent claim must include the KX modifier, certifying that continued treatment is medically necessary and fully supported by documentation.

Bryanne Halfhill
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