By Brandon Seigel, Chief Problem Solver · September 12, 2026 · 6 min read
What a complete request includes
- Current evaluation with standardized scores and functional impact
- Measurable, time-bound goals
- Proposed CPT codes and units per week, linked to diagnoses
- Plan of care with frequency and duration
- Referral or prescription and plan of care certification when required — especially for Medicaid
- Supporting letters from the pediatrician or specialist when helpful
Start re-authorizations early
Track visits used against visits approved and the authorization end date. Submit progress notes and re-authorization requests before either runs out, so care isn't interrupted.
Common reasons requests are denied
- Goals that aren't measurable or functional
- Missing referral or plan of care certification
- Codes requested that don't match the evaluation
- Progress not clearly documented at re-authorization
Quick answers
What documents are needed for a pediatric therapy prior authorization?
Typically the evaluation, measurable goals, proposed CPT codes and units, the plan of care, any required referral or certification, and supporting physician letters when helpful.
See exactly what's included in our medical billing services for therapy practices, how our percentage-of-collections pricing works, or browse common questions from practice owners.
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