Prior authorization for physiotherapy and extra sessions

Physiotherapy is usually authorised in blocks, and the hard part is often the second block. Reviewers want to see measured deficits at the start, goals tied to function, and objective progress since the last review. A plan of care that reads the same at session 12 as at session 1 invites a refusal.

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What reviewers look for in a therapy plan

The diagnosis being treated and, after surgery, the procedure and its date.
Baseline measurements: joint range in degrees, strength grades, balance or gait tests, and a validated disability or outcome questionnaire suited to the region.
Functional limits in daily terms: stairs, dressing, lifting, return to work, sport.
Goals that can be measured, each with a target date.
Frequency and duration requested, such as twice weekly for six weeks.
Why the patient needs a therapist's skill rather than a home exercise programme alone: post-operative protocol, manual techniques, supervision for safety, or poor progress with home exercise.

For an extension, add the same measurements repeated, the change since baseline, which goals were met, and what remains to reach a safe discharge point.

Structure of a request for more sessions

Summarise the episode so far. Diagnosis, start date and number of sessions used.
Show progress in numbers. Baseline value, current value and the goal, side by side.
Explain what is left. The remaining deficit and why it still limits function.
Justify skilled care. Name the interventions that need a therapist and why the home programme alone is not enough yet.
State the request. Number of sessions, frequency and the planned discharge point.

Example

Example extension request excerpt: after knee replacement

Request: 8 further sessions, twice weekly for 4 weeks.
Diagnoses: Aftercare following joint replacement surgery (Z47.1); presence of right artificial knee joint (Z96.651).

[Patient initials], 68, underwent right total knee replacement 7 weeks ago and has attended 12 sessions.

Progress (baseline at week 1 / today / goal):
- Knee flexion: 70 / 98 / 110 degrees
- Knee extension lag: 15 / 5 / 0 degrees
- Timed up-and-go: 24 / 14 / under 12 seconds
- Stairs: unable / one step at a time with rail / reciprocal with rail

Flexion has plateaued with home exercise over the last 10 days. Continued supervised mobilisation and progressive strengthening are needed to reach the range required for reciprocal stairs and car transfers. Discharge to a home programme is planned at the end of this block.

Invented example for illustration. Not a real patient.

Why therapy extensions are refused

The most common reason is that progress is described but not measured: 'improving well' or 'still stiff' gives the reviewer nothing to compare. The second is maintenance: when a patient has stopped improving and the request reads like ongoing exercise supervision, reviewers conclude that a home programme would do. The third is a goal that cannot be reached, such as full range after a fused joint.

If progress has stalled, say so and explain what will change in the next block, such as a different technique, a reassessment or a referral, rather than asking for more of the same.

Using ClearPass for therapy requests

Therapists and physicians can transcribe the reassessment session or type the measurements into the note. ClearPass then drafts the authorisation or extension request in Concise, Standard or Detailed length, with ICD-10 codes and procedure codes where your system uses them, such as 97110 for therapeutic exercise. If the note gives today's range but no baseline, it asks for the missing figure. The letter is a draft for you to check and file yourself. See also AI scribe for physiotherapy for the day-to-day notes.

What ClearPass does not do

It does not replace your judgement. Every note is an AI draft that you review and correct before it is used.
It is not a medical device and does not make clinical decisions. It is a documentation aid.
It does not connect to your EMR. The note is copy-ready text that pastes into any system.

Privacy

Clinical note content is not stored on ClearPass servers: it is processed to write the note, then discarded. Consultation audio is transcribed and discarded, never stored. Your note history stays in your browser, on your device, and you choose how long it is kept. Common identifiers are removed from typed and transcribed text before it reaches the AI; that is a best-effort safeguard, so leave names, ID numbers and file numbers out where you can. Processing goes through the AI providers named in our Privacy Policy, which sets out exactly what each one receives and how long it keeps it. ClearPass does not sign HIPAA business associate agreements today.

Questions

Can a physiotherapist use ClearPass or only doctors?

Any clinician who writes the notes can use it. The Rehabilitation and Therapy group has guided templates, and any therapy note can be written with the note structures or your own headings.

Which outcome measures should I include?

Use the validated measures your service already collects for that body region, and repeat the same ones at each review so change can be shown. The letter carries whatever is documented.

Does it know how many sessions the payer allows?

Not outside the one country where it holds a rules pack. Elsewhere the letter argues the clinical need for the number of sessions you request.

Try it on your next clinic day

The full product for 7 days, with no card and no automatic charge. Then $78 a month or $858 a year. Pricing details.

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