Coverage Policies

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Current policies effective through April 30, 2024.

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QualChoice follows care guidelines published by MCG Health.

Clinical Practice Guidelines for Providers (PDF)

QualChoice reserves the right to alter, amend, change or supplement medical policies as needed. QualChoice reviews and authorizes services and substances. CPT and HCPCS codes are listed as a convenience and any absent, new or changed codes do not alter the intent of the policy.

INDEX:



Effective Date: 01/01/2008	Title: Physical Performance Testing
Revision Date: 01/01/2013	Document: BI226:00
CPT Code(s): 9770
Public Statement
*Effective Date:* a) This policy will apply to all services performed on or after the above Revision date which will become the new effective date. b) For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply. 1) QualChoice supports appropriate physical and occupational health treatment for rehabilitation under restrictions noted in the coverage documents. 2) Physical performance testing (97750) is not a reimbursable service.
Medical Statement
1) The formal assessment of physical performance is part of a normal physical therapy or occupational therapy evaluation. Separate billing for this assessment will not be recognized. 2) Every physical therapy visit entails a reassessment of the progress of the rehabilitative effort as an essential component of the visit, but not as a separately billable event. Assessment of physical performance is one element of the reassessment of the progress of therapy. 3) When a formal periodic reassessment of progress in physical or occupational therapy is performed, an assessment of physical performance is an inherent part of that reassessment, and is not a separately billable service. 4) 97750 is not a separately reimbursable service. 5) When a functional capacity evaluation is performed for purposes of evaluating disability or evaluating an individual’s capacity for performing a particular job, such testing is considered administrative rather than Medically Necessary, and the testing is not covered. Codes Used In This BI: 97750 Physical performance test
Application to Products
This policy applies to all health plans administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet. Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) for those plans insured by QualChoice. In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC, the SPD or EOC, as applicable, will prevail. State and federal mandates will be followed as they apply.
Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.

This policy has recently been updated. Please use the index above or enter policy title in search bar for the latest version.