• Certification and Ongoing Responsibilities
  • Introduction
  • Other Facilities
  • Responsibilities
  • Supervision Requirements
    • Introduction
    • Declaration of Supervision
    • Supervision Waiver
  • Durable Medical Equipment and Disposable Medical Supplies
• Provider Communication
  • Introduction
  • Coordination with School-Based Services Providers
  • Coordination with County Birth to 3 Programs
  • Therapy Services for Children Brochure
  • Guide to Obtaining Augmentative Communication Devices and Accessories
  • Directory of Used Medical Equipment
• Documentation Requirements
  • Introduction
  • Prescriptions
  • Evaluations
  • Plan of Care
  • Daily Entries
• Services and Requirements
  • Introduction
  • Initial Spell of Illness
  • Daily Limitations
  • Duplicate Services
  • Evaluations
  • Group Therapy
  • Natural Environments
  • Durable Medical Equipment and Disposable Medical Supplies
  • HealthCheck "Other Services"
  • Services Not Separately Reimbursable
  • Reimbursement Not Available
• Codes
  • Procedure Codes
    • Introduction
    • Unit of Service
  • Modifiers
  • Place of Service Codes
  • Diagnosis Codes
• Prior Authorization
  • Introduction
  • Prior Authorization Forms and Attachments
  • Medical Necessity
    • Introduction
    • Relationship of Medical Necessity to Clinical Practice Principles
  • Flexibility of Approved Services
    • Introduction
    • Plan of Care Must Reflect Flexibility of Approved Services
    • Duration of Approved Services
    • Coordinating Multiple Prior Authorization Requests
• Requesting Extension of Therapy, Maintenance Therapy, and Services That Always Require Prior Authorization
  • Introduction
  • Approval Criteria
  • Extension of Therapy
  • Maintenance Therapy
    • Introduction
    • Direct Maintenance
    • Monitoring Maintenance
    • Discontinuing Maintenance
  • Services That Always Require Prior Authorization
    • Introduction
    • Cotreatment
    • Dual Treatment
    • Unlisted Procedure Codes
    • Decubitus Ulcers
• Requesting Spell of Illness
  • Introduction
  • Maximum Allowable Treatment Days
    • Introduction
    • Unused Treatment Days
• Extension of Therapy vs. Spell of Illness
• Requesting Services for Birth to 3 Participants
  • Introduction
  • Situations That Do Not Qualify for Birth to 3
• Requesting Amendments
  • Introduction
  • Approval Criteria
  • Reasons for Denial
• Claims
  • Introduction
  • 837 Health Care Claim: Professional
  • CMS 1500
  • Provider Numbers
    • Individual Providers
    • Groups, Clinics, and Nursing Homes
    • Rehabilitation Agencies
    • Hospitals
  • Referring Provider
  • Evaluations
  • Services Provided Beyond Daily Limits
  • Unlisted Procedure Codes
  • Multiple Services During One Session
  • Submitting Claims for Birth to 3 Services
• Reimbursement
  • Maximum Allowable Fees
  • Reimbursement Methods
    • Introduction
    • Natural Environment Enhanced Reimbursement
  • Copayment
    • Introduction
    • Annual Copayment Maximum
• Appendix
• PDF

Requesting Spell of Illness

Maximum Allowable Treatment Days

An SOI begins with the first day of evaluation or treatment and ends when the services are no longer required or after the allowable treatment days have been used, whichever comes first. The allowable treatment days include any treatment days covered by other health insurance sources or any treatment days provided by another provider in any setting.

The maximum allowable treatment days that may be granted for each ICD-9-CM code have been determined separately for each therapy discipline. There are two charts for each therapy discipline. Refer to Appendices 19 and 20 of this handbook for PT services, Appendices 21 and 22 of this handbook for OT services, and Appendices 23 and 24 of this handbook for SLP services. The two charts for each therapy discipline contain the same information, but are organized differently. Appendices 19, 21, and 23 of this handbook are organized alphabetically by the ICD-9-CM code description. Appendices 20, 22, and 24 of this handbook are organized by statements “A” through “F” of the PA/SOIA. Providers should use the appendix that best suits their needs. Instructions for reading each chart are included at the top of the appendix. Providers should use the appendices to determine the allowable combinations of ICD-9-CM codes and statements for SOI approval.

Only the ICD-9-CM codes that are listed in the appendices are available for SOI approval. If the ICD-9-CM code is not listed for the appropriate therapy discipline, the PT, OT, or SLP provider should submit the PA/TA (fillable PDF, 134 KB).

Next — Requesting Spell of Illness, Maximum Allowable Treatment Days, Unused Treatment Days
Previous — Requesting Spell of Illness