Physical Therapy Criteria
Reviewed: 2/07, 2/08, 1/9, 3/10, 2/11, 1/12, 1/13, 3/14,2/15, 1/16, 1/17
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:
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.
Physical therapy is expected to result in significant therapeutic improvement over a clearly defined period of time.
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