Physical Therapy

(a) Physical therapy when medically necessary is covered; provided, that the therapy must be to restore a bodily function that once existed, or has been lost or damaged due to disease or accidental injury. Coverage is only to the extent that it restores function to the status of function prior to the disease or accidental injury. (1) Therapy must result in significant and demonstrable improvements in the patient’s ability to function independently. (2) Benefit is limited to treatments by a physical therapist. (3) The first twenty (20) visits are covered in full. (4) A fifty percent (50%) co-insurance is required for all subsequent treatments meeting the criteria set forth in subsection (a) above. (b) Services Not Covered. The following are not covered under the physical therapy benefit: (1) services determined not to result in significant and demonstrable improvements in the patient’s ability to function independently. (c) Limitations and Exclusions. All physical therapy services are subject to the stated benefit limitations and exclusions outlined in § 2912 through § 2913. SOURCE: Added by P.L. 25-163:1 (Sept. 21, 2000),repealed/reenacted by P.L. 27-030:2 (Sept. 30, 2003). 2017 NOTE: This section was originally entitled “Durable Medical Equipment.” Added by P.L. 25-163:1, and repealed by 27-030:2.