Get Metroplus Physical Therapy

Filling out the Metroplus Physical Therapy form online can be a straightforward process with the right guidance. This guide will walk you through each step, ensuring you complete the form correctly and efficiently.

Follow the steps to complete the Metroplus Physical Therapy form accurately.

1. Click ‘Get Form’ button to obtain the form and open it for editing. This will provide you the necessary template to begin your application.
2. Provide your personal details in the Member Name, Date of Birth, and MetroPlus Member ID # sections. Ensure that all information is accurate to avoid any processing delays.
3. Indicate the type of therapy you are requesting by checking the appropriate box for Speech Therapy, Physical Therapy, or Occupational Therapy.
4. Input the relevant ICD-10 Diagnosis Code(s) and CPT/Procedure Code(s) in the designated fields. This information is crucial for processing your request accurately.
5. If applicable, check the boxes for Worker’s Compensation and No-Fault, and provide the Date of Injury and Date of Surgery if needed.
6. Fill in the name and contact details of the referring provider, including their phone number and Tax ID or NPI#.
7. Document the Date of Initial Visit and Date of Last Visit, along with the number of visits and frequency that you are requesting.
8. If you have had previous treatments, indicate this and provide the dates. Also, include information regarding progress since the last request for therapy, detailing ambulation, transfers, pain control, and activities of daily living.
9. Confirm if a home program is in place by answering the question provided. Provide additional notes if necessary.
10. Input the Speech/Physical/Occupational Therapist's information, including their phone number, provider ID# or Tax ID, address, and fax number.
11. After completing all sections, review your entries for accuracy and completeness. Incomplete or illegible forms may delay the request.
12. Finally, save your changes, download the completed form, and prepare to fax it to 1.212.908.8521 or 8522.

Start completing your Metroplus Physical Therapy request form online today for timely processing!