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Physical Therapy Criteria

Approved:  8/06
Reviewed:  2/07, 2/08, 1/9, 3/10, 2/11, 1/12, 1/13, 3/14,2/15, 1/16, 1/17
Revised: 
 
Physical therapy treatment consists of a prescribed program to relieve symptoms, improve function and prevent further disability for enrollees with acute or chronic disease or injury. 

Physical therapy is covered when all of the following criteria are met:

  1. Physical therapy is prescribed by an appropriate health care provider to improve or restore lost or impaired physical function or reduce pain resulting from illness, injury, congenital defect or surgery.

  2. Physical therapy is expected to result in significant therapeutic improvement over a clearly defined period of time.

  3. An individualized written physical therapy program outlines quantifiable, attainable treatment goals.

Physical therapy services must:

  • Relate directly  and specifically to an active written treatment regimen established by the physician after any needed consultation between the licensed physical therapist and physician
  • Establish a plan of treatment for outpatient physical therapy that is approved by the physician

Physical therapy is no longer considered medically necessary when:

  • There is no measurable improvement in the condition being treated
  • No improvement or stabilization occurs, despite alterations in the treatment program

ConnectCare

Utilization Management

ConnectCare's Utilization Management Staff is available to address questions and issues related to case management and utilization by using the telephone or fax numbers listed below.

ConnectCare Medical Management
4000 Wellness Drive
Midland, MI 48670
Toll free: 888-646-2429
Local: 989-839-1613
Fax: 989-839-1679
 
Hours of Operation
8:00 a.m. - 12:00 p.m.
1:00 p.m. - 5:00 p.m.
Monday - Friday (Eastern Time)

After normal business hours, inbound communications and information may be relayed via fax, confidential voice mail or electronic mail. All precertification requests and/or communications received after normal business hours are returned on the next business day and communications received after midnight on Monday through Friday are responded to on the same business day.