The following applies to functional capacity evaluations
(FCEs). A maximum of three FCEs for each compensable injury shall be billed and
reimbursed. FCEs ordered by the division shall not count toward the three FCEs
allowed for each compensable injury. FCEs shall be billed using CPT code 97750
with modifier "FC." FCEs shall be reimbursed in accordance with §
134.203(c)(1) of
this title. Reimbursement shall be for up to a maximum of four hours for the
initial test or for a division ordered test; a maximum of two hours for an
interim test; and a maximum of three hours for the discharge test, unless it is
the initial test. Documentation is required. FCEs shall include the following
elements:
(1) A physical examination
and neurological evaluation, which include the following:
(A) appearance (observational and
palpation);
(B) flexibility of the
extremity joint or spinal region (usually observational);
(C) posture and deformities;
(D) vascular integrity;
(E) neurological tests to detect sensory
deficit;
(F) myotomal strength to
detect gross motor deficit; and
(G)
reflexes to detect neurological reflex symmetry.
(2) A physical capacity evaluation of the
injured area, which includes the following:
(A) range of motion (quantitative
measurements using appropriate devices) of the injured joint or region;
and
(B) strength/endurance
(quantitative measures using accurate devices) with comparison to contralateral
side or normative database. This testing may include isometric, isokinetic, or
isoinertial devices in one or more planes.
(3) Functional abilities tests, which include
the following:
(A) activities of daily living
(standardized tests of generic functional tasks such as pushing, pulling,
kneeling, squatting, carrying, and climbing);
(B) hand function tests that measure fine and
gross motor coordination, grip strength, pinch strength, and manipulation tests
using measuring devices;
(C)
submaximal cardiovascular endurance tests which measure aerobic capacity using
stationary bicycle or treadmill; and
(D) static positional tolerance
(observational determination of tolerance for sitting or standing).
Notes
28
Tex. Admin. Code §
134.225
Adopted by
Texas
Register, Volume 41, Number 27, July 1, 2016, TexReg
4839, eff.
7/7/2016
