For Physical Therapists ·
What you'll accomplish
By the end of this guide, you'll have Claude set up as a dedicated prior authorization specialist with your clinic's information, insurer-specific language preferences, and your most common diagnoses pre-loaded. Instead of spending 30–45 minutes per auth letter, you'll produce professional, insurer-tailored letters in under 10 minutes.
What you'll need
What you should see: A new project workspace with a persistent instructions field at the top.
Troubleshooting: If you don't see "Projects," it may not be in your plan tier. Free Claude accounts have project access; if unavailable, use Claude's "Custom Instructions" setting instead.
In the Project Instructions box, write:
You are a prior authorization specialist for an outpatient physical therapy clinic. Your job is to write prior authorization letters to insurance companies for PT services.
Clinic context: [Your clinic name], outpatient orthopedic/sports PT. Treating licensed DPTs.
When writing prior auth letters:
- Emphasize functional limitations and their specific impact on the patient's activities of daily living, work, and quality of life
- Use medical necessity language: skilled PT services are required because [condition] creates functional deficits requiring the clinical expertise of a licensed PT
- Reference relevant diagnoses with specific objective measurements (ROM, strength grades, pain levels, functional scores)
- Specify CPT codes when provided (97110 therapeutic exercise, 97140 manual therapy, 97012 traction, etc.)
- For Medicare and Medicare Advantage: emphasize skilled services, not just maintenance — what can ONLY be done by a PT
- Tailor language to each insurer's known criteria when specified
Insurer-specific notes:
- Medicare/Medicare Advantage: focus on "skilled care" and "functional progress," avoid language suggesting maintenance only
- Aetna: emphasizes "evidence-based treatment" and "functional outcomes"
- BCBS: responds well to specific ROM/strength measurements and return-to-work framing
- UnitedHealthcare: cite clinical practice guidelines when possible
In the same project, start a new conversation and create a master template for each of your top 5 diagnoses. Type:
Create a prior auth letter template for [diagnosis] that I can fill in with patient-specific information. Include blank fields in [brackets] for: patient demographics, specific ROM/strength measurements, functional limitations, visit count requested, and treatment interventions.
Save Claude's output as a text file. Build this template library for your most common diagnoses: lumbar disc herniation, shoulder rotator cuff repair post-op, knee replacement post-op, cervical radiculopathy, hip osteoarthritis.
In your Prior Auth project, start a new conversation. Use this structure:
Write a prior auth letter to [Insurer name].
Patient: [age]yo [sex], [diagnosis].
Functional limitations: [specific list — what they cannot do].
Objective findings: [ROM, strength, pain levels, functional test scores].
Requesting: [number] visits of PT over [timeframe].
Interventions: manual therapy (97140), therapeutic exercise (97110), [other CPT codes].
Goal: [functional outcome — return to work, safe ambulation, etc.].
Additional context: [post-surgical, failed conservative treatment, work injury, etc.]
Read the letter carefully for:
Medicare post-surgical auth:
Prior auth letter to Medicare for [surgery type] post-op, [timeframe post-op]. Patient: [age]yo with Medicare. Skilled care needed because: [functional deficits requiring licensed PT expertise]. ROM: [measurements]. Functional limitations: [ADL/mobility limitations]. Requesting [number] visits for manual therapy and therapeutic exercise per Medicare guidelines.
Commercial insurance first auth:
Prior auth letter to [insurer] for outpatient PT, [diagnosis]. Patient: [age]yo [sex], [occupation]. Mechanism/onset: [history]. Functional limitations affecting work/ADLs: [specific list]. Objective findings: [measurements]. Requesting [number] visits over [timeframe] for [CPT codes]. Expected outcome: [functional goal].
Workers' comp authorization:
Prior auth letter for workers' compensation, [employer/insurer]. Patient injured [mechanism of injury]. Work restrictions: [current restrictions]. Treatment needed: [PT interventions]. Goal: return to full duty work as [job title] within [timeframe]. Requesting [number] visits.