Coverage for physical medicine is determined according to individual or group customer benefits.  Participating, preferred and network providers can bill the member for denied services that exceed the member's benefit limitations.

Physical medicine is a covered service when performed with the expectation of restoring the patient's level of function that has been lost or reduced by injury or illness.

This type of therapy should be provided in accordance with an ongoing, written treatment plan. The treatment plan should include, at a minimum, documentation of the following:  

• The patient’s case history;
• Findings of all examinations performed including functional limitations;
• Condition severity (mild, moderate, or severe);
• Findings of any diagnostic studies;
• Clinical impression, including rationale for changes in diagnosis;
• Treatment plan to include long and short-term goals along with a reasonable estimation of duration (i.e., number of weeks) and frequency (i.e., number of visits);
• Informed consent;
• Progress notes for each date of service to follow subjective, objective, assessment, and plan format along with signature of provider who rendered the service(s);
• Recording of the specific physical medicine modalities/procedures to be used in treatment, documentation of time for constant attendance modalities and therapeutic procedures, and identification of equipment and/or techniques utilized

The treatment plan should be updated as the patient's condition changes. Treatment plans for physical medicine, aquatic therapy, and gait training must be maintained in the medical record, and made available upon request.

A typical session usually consists of up to one hour of rehabilitative therapy which could include up to four physical medicine modalities/procedures and/or units performed on the same date of service, per performing provider.

Reimbursement for PT/OT visits involving any of the physical medicine codes [modalities (97010-97039, G0283, S8950), therapeutic procedures (97110-97542), tests and measurements (97750), muscle range of motion testing (95831-95852), orthotic management and prosthetic management (97760-97762)] are limited as follows: up to four codes/units in any combination per date of service per performing provider. Payment will be based on the highest submitted and allowed physical medicine codes. Services exceeding the limitation will be considered not medically necessary.

Examples of billing for covered services within a visit wherein up to four codes/units are reimbursed:

 

Procedure codes 97010 + 97014 + 97035 + 97140

 

Procedure codes 97140 + 97010 + 97110 + 97110

 

Procedure codes 97113 + 97113 + 97113 + 97113

 

Procedure codes 97110 +97110 + 97530 +97530 

Duplicate therapy is not considered medically necessary and, therefore, non-covered. For example, if an individual is receiving therapy services from two different providers who are treating the same condition, the components of the treatment sessions must be different (eg, OT should focus on the self-care/home management/adaptive equipment use, while PT should focus on strength and range of motion. If two different providers are treating different conditions, for instance, one provider is treating the hand and the other provider is treating the knee, this would not be considered a duplicate therapy. 

Services that do not meet the medical necessity criteria on this policy will be considered not medically necessary. A participating, preferred or network provider cannot bill the member for the denied service unless the provider has given advance written notice, informing the member that the service may be deemed not medically necessary and providing an estimate of the cost. The member must agree in writing to assume financial responsibility, in advance of receiving the service. The signed agreement should be maintained in the provider's records.

Physical Medicine or Athletic Training Evaluation
An Evaluation and Management (E&M) service is considered an inherent part of a physical medicine evaluation (97001-97002) or athletic training evaluation (97005-97006). The E&M service is not eligible for separate payment when reported on the same day as a physical medicine evaluation or athletic training evaluation.

Consequently, when an Evaluation and Management service is reported in conjunction with a physical medicine evaluation or athletic training evaluation, the services should be combined under the appropriate code for the physical medicine evaluation or athletic training evaluation. A participating, preferred, or network provider cannot bill the member for the E&M service. Modifier "-25" may be reported with medical care (e.g. E/M visits, consultations) to identify it as significant and separately identifiable from the other service(s) provided on the same day. When modifier "-25" is reported, the patient’s medical records must clearly document that separately identifiable medical care was rendered.

Muscle testing (95831-95834), range of motion testing (95851-95852), and physical performance testing (97750) are considered components of a physical medicine evaluation (97001-97002) or an athletic training evaluation (97005-97006), and are not eligible for separate payment when billed on the same date of service as a physical medicine evaluation or athletic training service.  Modifier "-59" may be reported with a non-E/M service, to identify it as distinct or independent from other non-E/M services performed on the same day. When modifier "-59" is reported, the patient’s medical records must support its use in accordance with CPT guidelines.

Maintenance Therapy
Physical medicine services performed repetitively to maintain a level of function is not eligible for payment. A maintenance program consists of activities that preserve the patient's present level of function and prevent regression of that function. These services generally would not involve complex physical medicine and rehabilitative procedures, nor would they require clinical judgment and skill for safety and effectiveness. Maintenance begins when the therapeutic goals of a treatment plan have been achieved, or when no additional functional progress is apparent or expected to occur. Maintenance therapy should be reported under procedure code S8990 (physical or manipulative therapy performed for maintenance rather than restoration). A participating, preferred, or network provider can bill the member for the denied service.

Physical Medicine Modalities
Physical medicine modalities vary according to whether direct (one-on-one) or supervised contact is required for the treatment.

• Supervised Modalities 
  Supervised modalities (codes 97010-97028) do not require direct one-on-one patient contact by the provider. These are not time-based codes. Therefore, it is not appropriate to report multiple units of services with codes 97010-97028. Report these codes only once during a patient encounter (visit), regardless of the amount of time spent supervising the modality or the number of body areas treated.
  
  Hot/Cold Packs: Code 97010 should be reported only one time for the use of both cold and hot packs during the same treatment session/visit.

Vasopneumatic Compression (97016)
Intermittent compression therapy is used to reduce edema and lymphedema of the extremities. This treatment is warranted for the following conditions:

• Edema of the extremities
• Hematoma of the leg
• Lymphedema of the arm
• Lymphedema of the leg
• Venous insufficiency or venous stasis disorder

Conditions other than those listed above or those which indicate that an infection is present should be denied as not medically necessary. A participating, preferred or network provider cannot bill the member for the denied service unless the provider has given advance written notice, informing the member that the service may be deemed not medically necessary and providing an estimate of the cost. The member must agree in writing to assume financial responsibility, in advance of receiving the service. The signed agreement should be maintained in the provider's records.

Documentation to support the application of a compression device should include the type, amount and location of the edema as well as the circumferential measurements of the treated extremity, before and after treatment.

This service is considered a “supervised” modality and is not considered “time-based.” It should be reported only once per treatment session, regardless of the number of areas treated or the length of time required to complete treatment.

Services provided by devices that provide both vasopneumatic compression and cold therapy simultaneously, should be reported with code 97016. It is not appropriate to report cold therapy (97010) with vasopneumatic compression (97016) when services are provided simultaneously with the same device.

Infrared Therapy (97026)
The use of infrared and near-infrared light and heat, including monochromatic infrared energy, is not considered medically necessary when used as a physical medicine modality for the treatment of diabetic and/or non-diabetic peripheral sensory neuropathy and wounds and/or ulcers of the skin and/or subcutaneous tissues.

Infrared therapy, code 97026, will be denied as not medically necessary when reported for diagnosis codes listed in the Diagnosis Code Section of this policy.

A participating, preferred or network provider cannot bill the member for the denied service unless the provider has given advance written notice, informing the member that the service may be deemed not medically necessary and providing an estimate of the cost. The member must agree in writing to assume financial responsibility, in advance of receiving the service. The signed agreement should be maintained in the provider's records.

• Constant Attendance Modalities
  Constant attendance modalities (codes 97032-97039) are those modalities that require direct one-on-one patient contact by the provider. These are time-based codes that include the time required to perform all aspects of the service, including pre,- intra-, and post-service work. Documentation must include the amount of time spent in providing all aspects of this service.
  
  Direct one-on-one contact requires that the provider maintain visual, verbal and/or manual contact with the patient throughout the procedure. The time frames indicated for the therapeutic procedures describe the total time (i.e., pre-service, intra-service, and post-service time) spent performing the clinical skills and/or services that attempt to improve function. Documentation in the medical record for therapeutic procedures must ascertain that the total number of minutes of treatment for services represented by timed codes is consistent with the number of units billed for those services.
  
  When two constant attendance modalities are performed at the same time, using one device, the code representing the primary modality should be reported. For instance, when electrical stimulation and ultrasound are performed together using a device such as the Sonicator, report the ultrasound code. It is not appropriate to report both modalities for the same 15-minute period of time.

Aquatic Therapy (97113)
Procedure code 97113 should be used to report aquatic therapy with therapeutic exercises. Aquatic therapy must be performed with the expectation of restoring a patient's level of function that has been lost or reduced by injury or illness. Aquatic therapy performed to maintain a level of function is considered to be a maintenance program and is not eligible for payment.

A provider must have direct (one to one) patient contact when reporting aquatic therapy. Supervising multiple patients in a pool at one time and billing for each of these patients per 15 minutes of therapy time is not acceptable.

Before beginning an aquatic therapy program, the provider must prepare a treatment plan that includes short-term and long-term goals that the patient can be reasonably expected to accomplish through the aquatic therapy program and the specific methods chosen.  

Proper documentation should include:

• Documentation indicating whether the patient was in shallow or deep water. An aquatic therapy program undertaken for upper extremity exercises should take place in a depth of water that allows the patient's upper extremities to be submerged. Water depth should be at a level that provides the best postural position for exercise therapy.
• For resistance and strengthening exercises, the provider should document the number of repetitions, the number of sets, the type(s) of equipment, which body area(s) and the specific type(s) of exercise performed by the patient for each therapy session.

NOTE:

If a provider cannot substantiate increased resistance experienced as the patient exercises in water, the session will be considered as endurance or conditioning rather than progressive resistance exercises (PRE) to strengthen.

• Specific documented goals regarding decreasing inflammation, decreasing pain, increasing circulation, increasing strength, etc., and the means by which the specific goals will be achieved.
• Periodic re-evaluation documenting the number of times the patient has had rehabilitative aquatic therapy, the patient's pain level before beginning the program, the current pain level and future goals for the patient's care.
• Indication of pool water temperature for each session.

Procedure code 97113 represents aquatic therapy with therapeutic exercise. Payment for procedure code 97113 includes whirlpool (97022) and/or Hubbard tank (97036). Separate payment will not be made for 97022 or 97036 in addition to 97113 for a single patient encounter. Modifier "-59" may be reported with a non-E/M service, to identify it as distinct or independent from other non-E/M services performed on the same day. When modifier "-59" is reported, the patient’s records must support its use in accordance with CPT guidelines.

Gait Training (97116)
Procedure code 97116 should be used to report gait training therapy. Gait training is a technique that restores a patient's normal stance, swing, speed, balance and sequence of muscle contractions for walking.

Generally accepted indications for gait training include:

• Foot drop resulting from stroke
• Herniated disc(s)
• Ankle, knee and/or hip replacement
• Traumatic amputations of the toe(s)

Documentation for gait training must demonstrate that the patient's gait was improved either by lengthening the gait or increasing the frequency of cadence lower-extremity.

Procedure code 97116 should not be used to report orthotics or prosthetics training. Orthotics training should be reported using procedure codes 97760 and 97762. Prosthetics training should be reported using procedure codes 97761 and 97762.

Vestibular Rehabilitation Therapy
Vestibular rehabilitation therapy generally refers to an individualized rehabilitation program for the treatment of patients with vertigo and disequilibrium. The therapy is designed to address the patient's specific complaints and functional deficits and may include specific exercises, gait training, balance retraining, and patient education and instructions for a home exercise program designed to decrease dizziness, improve balance function, and increase general activity levels. A vestibular rehabilitation program typically last 45 minutes per session and is prescribed 1-2 times per week. In general, patients remain in the program 4-8 weeks.

A vestibular rehabilitation program may be considered medically necessary for patients with vertigo, disequilibrium, and balance deficits related to the following conditions:

• peripheral vestibular disorders (e.g., labyrinthitis, neuritis, benign paroxysmal positional vertigo, post vestibular surgical symptoms, and bilateral vestibular loss),
• mixed {peripheral and central vestibular disorders, and
• central causes of vertigo (e.g., CVA, multiple sclerosis, and mild traumatic brain injury)

If none of these conditions are reported, a vestibular rehabilitation program is considered not medically necessary, and therefore, not covered.  A participating, preferred or network provider cannot bill the member for the denied service unless the provider has given advance written notice, informing the member that the service may be deemed not medically necessary and providing an estimate of the cost.  The member must agree in writing to assume financial responsibility, in advance of receiving the service.  The signed agreement should be maintained in the provider's records.

A vestibular rehabilitation program may include the following procedures:

• Physical medicine evaluation and re-evaluation (97001, 97002),
• Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility (97110),
• Therapeutic procedure, one or more areas, each 15 minutes: neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities (97112),
• Therapeutic procedure, one or more areas, each 15 minutes; gait training (includes stair climbing) (97116), and
• Therapeutic activities, direct (one on one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes (97530)
• Canalith repositioning procedure(s)(eg., Epley maneuver, Semont maneuver), per day (95992)

Act 62 – 2008 ((Autism Spectrum Disorders Coverage Mandate) Effective July 1, 2009

Act 62-2008 (Autism Spectrum Disorders Coverage Mandate) requires coverage for individuals who are under twenty-one (21) years of age for the diagnostic assessment and treatment of autism spectrum disorders.

Coverage is subject to a maximum benefit of thirty-six thousand dollars ($36,000) per year but is not subject to any limits on the number of visits to an autism service provider for treatment of autism spectrum disorders. Coverage is subject to copayment, deductible and coinsurance provisions, as well as any other general exclusions or limitations set forth in the member’s contract.

Non-Covered Services

The following services are considered experimental/investigational or not medically necessary and therefore, not covered:

Dry Hydro Massage (97799)
Hydrotherapy refers to the use of water in the treatment of disease or trauma. The patient lies back, completely clothed, on the surface of a hydrotherapy table. Under the surface is a mattress filled with heated water. A pump propels the water toward the patient through hydro-jets. The pressure of the water against the patient’s body provides the massage. A primary wave and a lighter secondary wave combine to produce a deep tissue massage to all areas of the spine simultaneously. The therapy can be applied to nearly every body part by changing the individual’s position on the table. This is unattended hands-free massage.

Dry hydro massage is considered not medically necessary. A participating, preferred or network provider cannot bill the member for the denied service unless the provider has given advance written notice, informing the member that the service may be deemed not medically necessary and providing an estimate of the cost. The member must agree in writing to assume financial responsibility, in advance of receiving the service. The signed agreement should be maintained in the provider's records.

The Profiler and Aqua PT are considered forms of dry hydro massage.

See Medical Policy Bulletin V-37 for guidelines on hydrotherapy provided to members with autism spectrum disorders.

Electromagnetic Stimulation (Code 97799)
Electromagnetic therapy devices create a magnetic field that penetrates the body creating nerve impulses that innervate smooth and striated muscles. This type of therapy is used for the treatment of bulk muscle excitation, relaxation of muscle spasms, maintaining or increasing range of motion, prevention or retardation of disuse atrophy, muscle re-education, increasing local blood circulation, and immediate post-surgical stimulation of the calf muscles to prevent venous thrombosis.

Because the effectiveness of electromagnetic stimulation has not been established, this service is considered experimental/investigational. A participating, preferred or network provider may bill the member for the denied therapy.

Equestrian/Hippotherapy (S8940)
Hippotherapy (Equestrian therapy) is a treatment modality that utilizes the movement of a horse as a tool to improve the patient’s neuromuscular function. Hippotherapy is used for patients with compromised neuromuscular function, e.g., cerebral palsy. The horse’s walk provides sensory stimulation through its rhythmic, repetitive movement. The goals of hippotherapy are to combine this treatment modality with other therapeutic modalities to improve balance, posture, mobility, and function.

Hippotherapy is considered experimental/investigational. Scientific evidence does not demonstrate the efficacy of this service. A participating, preferred, or network provider can bill the member for the denied service.

Low-Intensity Pulsed Ultrasound (Hands-Free Ultrasound)(97799)
Hands-free ultrasound is used as an alternative to traditional manual ultrasound. The lower intensity, pulsed treatment allows for a longer treatment time. In traditional ultrasound, the therapist manually moves the soundhead over the treatment area, whereas the stationary soundhead used in this method of ultrasound therapy does not require that the therapist remain with the patient during the duration of the treatment.

Hands-free ultrasound therapy is considered experimental/investigational. There is a lack of clinical studies showing that lower intensity ultrasound therapy is as effective as traditional ultrasound. 

Participating, preferred, and network providers can bill the patient for the denied service. Use procedure code 97799 (Unlisted physical medicine/rehabilitation service or procedure) to report this service.

Horizontal Therapy (97799)
Horizontal therapy is a form of bioelectrical stimulation. During horizontal therapy, electric current moves through tissues horizontally rather than vertically.

Horizontal therapy is considered experimental/investigational. Further studies are needed to determine the long-term efficacy of this modality. A participating, preferred, or network provider can bill the member for the denied service. Use procedure code 97799 (Unlisted physical medicine/rehabilitation service or procedure) to report this service.

Low-Level Laser Therapy (S8948) (Cold Laser Therapy)
Low-level laser therapy is the non-invasive application of red or cold (subthermal) laser light to injuries or wounds to improve soft tissue healing and relieve both acute and chronic pain (e.g., wound healing, carpal tunnel syndrome, and pain management).

Low-level laser therapy is considered experimental/investigational. This service is still being performed in a clinical trial setting with no long-term outcomes available. Further studies are needed to determine the long-term efficacy of this modality. A participating, preferred, or network provider can bill the member for the denied service.

For information on sensory integrative techniques, refer to Medical Policy Bulletin Y-2.

For information on manipulation services, refer to Medical Policy Bulletin Y-9.

For information on MLD, refer to Medical Policy Bulletin Y-11.

For information on cognitive rehabilitation, refer to Medical Policy Bulletin Y-21.

For information on interferential stimulation, refer to Medical Policy Bulletin E-45.

For information on electromagnetic therapy provided for the treatment of urinary incontinence, see Medical Policy Bulletin Y-12.

For information on Autism Spectrum Disorders, refer to Medical Policy Bulletin V-37.

Place of Service: Outpatient, Inpatient, Home, Office

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits or a contract. Benefits are determined by the Federal Employee Program.

Please note that POS members may self-refer for outpatient PM&R services.

When the member meets the medical necessity criteria detailed in this medical policy, please refer to the member's specific benefits schedule to determine and approve the duration of outpatient physical medicine services.

02/1993, Physical therapy reporting tips
05/1994, Physical therapy quick reference guide
06/1994, Outpatient physical therapy
01/1995, Physical therapy reporting tips
01/1995, Postoperative physical therapy
08/1995, Postoperative physical therapy
10/1996, Aquatic therapy
10/1996, Gait training
10/1996, Manipulation and physical therapy changes
10/1996, Therapy treatment plan
12/1996, Manipulation and physical therapy treatment plan: tips for completing form 3861
12/1996, Therapeutic activities - code 97530 - to remain physical therapy service
02/1997, Physical therapy quick reference guide
02/1998, New physical and occupational therapy coding guidelines adopted
06/2002, Manipulation and physical therapy reporting changes explained
08/2002, Highmark deletes routine maintenance therapy code
04/2003, Dry hydro massage
10/2003, Therapeutic neuromuscular education
02/2004, Guidelines on physical therapy, occupational therapy and athletic training evaluations
02/2005, How to report maintenance manipulations
04/2005, Hippotherapy considered investigational
10/2005, Aquatic therapy reporting guidelines outlined
10/2005, Blue Shield to apply occupational therapy benefits to code 97530
02/2006, Hands-free ultrasound therapy considered investigational
04/2006, Report hands-free ultrasound with code 97799
06/2006, Application of a vasopneumatic device eligible for specific indications
10/2006, Use code 97799 to report dry hydro massage
02/2007, Reporting guidelines for supervised PM&R modalities explained
06/2007, Blue Shield limits coverage of electromagnetic stimulation to treatment of chronic ulcers
06/2007, Infrared light therapy coverage indications outlined
06/2007, Horizontal stimulation considered investigational
12/2007, Report code 97799 for electromagnetic therapy performed for treating musculoskeletal conditions
12/2007, Constant and supervised attendance modalities reporting guidelines clarified
06/2010, Two constant attendance modalities performed at same time not paid separately
06/2012, Physical medicine guidelines revised

Aquatic Therapy
Hamer AR, Naylor JM, Crosbie J, Russell T. Land-based versus water-based rehabilitation following total knee replacement: A randomized, single-blind trial. Arthritis Rheum. 2009;61(2):184-191

Rahmann AE, Brauer SG, Nitz JC. A specific inpatient aquatic physiotherapy program improves strength after total hip or knee replacement surgery: A randomized controlled trial. Arch Phys Med Rehabil. 2009;90(5):745-755

Hillier S, McIntyre A, Plummer L. Aquatic physical therapy for children with developmental coordination disorder: A pilot randomized controlled trial. Phys Occup Ther Pediatr. 2010;30(2):111-124

Tinti G, Somera R Jr, Valente FM, Domingos CR. Benefits of kinesiotherapy and aquatic rehabilitation on sickle cell anemia. A case report. Genet Mol Res. 2010;9(1):360-364

Electromagnetic Stimulation
The Canadian Chiropractic Association, Canadian Federation of Chiropractic Regulatory Boards, Clinical Practice Guidelines Development Initiative, Guidelines Development Committee (GDC). Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash. J Can Chiropr Asso. 2005;49(3):158-209.

Work Loss Data Institute. Forearm, wrist, & hand (acute & chronic), not including carpal tunnel syndrome. Corpus Christi (TX). Work Loss Data Institute. 2008.

Work Loss Data Institute. Elbow (acute & chronic). Corpus Christi (TX). Work Loss Data Institute. 2008.

Benazzo F, Zanon G, Pederzini L, et al. Effects of biophysical stimulation in patients undergoing arthroscopic reconstruction of anterior cruciate ligament: prospective, randomized and double-blind study. Knee Surg Spors Traumatol Arthrosx. 2008;16:595-601.

Wróbel M, Szymborska-Kajanek A, Wystrychowski G, et al. Impact of low frequency pulsed magnetic fields on pain intensity, quality of life and sleep disturbances in patients with painful diabetic polyneuropathy. Diabetes & Metabolism. 2008;34:349-354.

Hedén P, Pilla A. Effects of Pulsed Electromagnetic Fields on Postoperative Pain: A Double-Blind Randomized Pilot Study in Breast Augmentation Patients. Aesth Plast Surg. 2008;32:660-666.

Foley K, Mroz T, Arnold P, et. al. Randomized, prospective, and controlled clinical trial of pulsed electromagnetic field stimulation for cervical fusion. The Spine Journal. 2008:436-442.

Weintraub M, Herrmann D, Smith G, Backonja M, Cold S. Pulsed Electromagnetic Fields to Reduce Diabetic Neuropathic Pain and Stimulate Neuronal Repair: A Randomized Controlled Trial. Arch Phys Med Rehabil. July 2009;90:1102-1109.

Sutbeyaz S, Sezer N, Koseoglu F, Kibar S. Low-frequency pulsed electromagnetic Field Therapy in Fibromyalgia: A Randomized, Double-blind, Sham-controlled Clinical Study. Clin J Pain. October 2009;25(8):722-728.

Ay S, Eveik D. The effects of pulsed electromagnetic fields in the treatment of knee osteoarthritis: a randomized, placebo-controlled trial. Rheumatol Int. 2009;29:663-666.

Dallari D, Fini M, Giavaresi G, et al. Effects of Pulsed Electromagnetic Stimulation on Patients Undergoing Hip Revision Prostheses: A Randomized Prospective Double-Blind Study. Bioelectromagnetics. 2009;30:423-430.

Kroeling P, Gross A, Goldsmith C, et al. Electrotherapy for neck pain. Cochrane Database of Systematic Reviews. 2009;Issue 4.

Kaskutas V, Snodgrass J. Occupational therapy practice guidelines for individuals with work-related injuries and illnesses. Bethesda (MD). American Occupational Therapy Association (AOTA). 2009.

Hands-Free Ultrasound
Frykberg RG, Zgonis T, Armstrong D, et al. Diabetic foot disorders: a clinical practice guideline. J Foot Ankle Surg. Sept-Oct 2006;45(5):S-2-66. www.guideline.gov/popups/printView.aspx?id=9846.

American College of Occupational and Environmental Medicine (ACOEM). Elbow disorders. American College of Occupational and Environmental Medicine (ACOEM). 2007. www.guideline.gov/popups/printView.aspx?id-10883.

Rand S, Goerlich C, Marchand K. The Physical Therapy Prescription. Am Fam Physician. Dec. 1, 2007;76(11):1661-1666.

Kaskutas V, Snodgrass J. Occupational therapy practice guidelines for individuals with work-related injuries and illnesses. Bethesda (MD). American Occupational Therapy Association (AOTA). 2009. www.guideline.gov/popups/printView.aspx?id=15288.

El-Bialy T, Hasan A, Janadas A, Albaghdadi T. Nonsurgical treatment of hemifacial microsomia by therapeutic ultrasound and hybrid functional appliance. Open Access Journal of Clinical Trials. 2010;2:29-36.

Gulich DR. Comparison of tissue heating between manual and hands-free ultrasound techniques. Physiother Theory Pract. 2010 Feb;26(2):100-6.

Hippotherapy
Helga E, Kakebeeke T, Hegemann D, Baumberger M. The Effect of Hippotherapy on Spasticity and on Mental Well-Being of Persons with Spinal Cord Injury. Arch Phys Med Rehabil. 2007;88:

Snider L, Korner-Bitensky N, Kammann C, Warner S, Saleh M. Horseback Riding as Therapy for Children with Cerebral Palsy: Is There Evidence of Its Effectiveness? Physical and Occupational Therapy in Pediatrics. 2007 27(2): 5-23

Silkwood-Sherer D, Warmbier H, Effects of Hippotherapy on Postural Stability, in Persons with Multiple Sclerosis: A Pilot Study. JNPT. June 2007;31: 77-84

Murphy D, Kahn-D'Angelo K, Gleason J. The Effect of Hippotherapy on Functional Outcomes for Children with Disabilities: A Pilot Study. Pedistr Phys Ther Fall 2008 20(3):264-70

Anttila H, Autti-Rämö, Suoranta J, Mäkelä M, Malmivaara A. Effectiveness of physical therapy interventions for children with cerebral palsy: A systematic review. BMC Pediatrics. April 24, 2008; 8(14)

Johnson C. The Benefits of Physical Activity for Youth with Developmental Disabilities: A Systematic Review.  Health Promotion. January/February 2009;23(3): 157-167

Debuse D, Gibb C, Chandler C. Effects of hippotherapy on people with cerebral palsy, from the users’ perspective: A qualitative study. Physiotherapy Theory and Practice. 2009; 25(3): 174 -  192

McGee M, Reese N. Immediate Effects of a Hippotherapy Session on Gait Parameters in Children with Spastic Cerebral Palsy. Pediatric Physical Therapy. 2009;21: 212-218

Oppenheim W. Complementary and alternative methods in cerebral palsy. Developmental Medicine & Child Neurology. 2009;51(4): 122-129

McGibbon N, Benda W, Duncan B, Silkwood-Sherer D. Immediate anhd Long-Term Effectis of Hippotherapy on Symmetry of Adductor Muscle Activity and Functional Ability in Children with Spastic Cerebral Palsy. Arch Phys Med Rehabil. June 2009;90: 966-974.

Horizontal Stimulation
California Technology Assessment Form. Interferential Stimulation for the Treatment of Musculoskeletal Pain. October 19, 2005.

Demirtürk F, Akbayrak T, Karakaya C, et al. Interferential current versus biofeedback results in urinary stress incontinence. SwissMed Wkly. 2008;138(21-22):317-321.

Kajbafzadeh A, Sharif-Rad L, Baradaran N, Nejat F. Effect of Pelvic Floor Interferential Electrostimulation on Urodynamic Parameters and Incontinency of Children with Myelomeningocele and Detrusor Overactivity. Urology. August 2009;74(2).

Chen C, Johnson M. An Investigational Into the Effects of Frequency-Modulated Transcutaneous Electrical Nerve Stimulation (TENS) on Experimentally-Induced Pressure Pain in Health Human Participants. J Pain. October 2009;10(10):1029-1037.

Clarke M, Chase J, Gibb S, et al. Improvement of quality of life in children with slow transit constipation after treatment with transcutaneous electrical stimulation. J Ped Surg. 2009;44:1268-1273.

Clark M, Chase J, Gibb S, et al. Decreased colonic transit time after transcutaneous interferential electrical stimulation in children with slow transit constipation. J Ped Surg. 2009;44:408-412.

Duffy R. Low Back Pain: An Approach to Diagnosis and Management. Primary Care: Clinics in Office Practice. Dec. 2010;37(4).

Horizontal Therapy (Interferential Stimulation)
CMS National Coverage Determination: Infrared Therapy Devices (CAG-0029IN), Oct. 4, 2006

Saggini R, Carniel R, Cancelli F. Treatment of Shoulder Injuries with Associated Arthrosynovitis Using Horizontal Therapy. Eur Med Phys. 2006; 42(Suppl. 1 to No 2): 669-72

Zambito A, Bianchini D, Gatti D, Rossini M, Adami S, Viapiana O. Interferential and horizontal therapies in chronic low back pain due to multiple vertebral fractures: a randomized, double blind, clinical study. Osteoporos Int. 2007; 18(11): 1541-5

Low Level Laser
Crawford F, Thomson C.  Interventions for treating plantar heel pain.  Cochrane Database of Systemic Reviews, 2003, Issue 3. www.mrw.interscience.wiley.com/cochrane/clsysrev.
Accessed June 22, 2009

Mazzetto M, Carrasco T, Bidinelo E, Pizzo R, Mazzetto R. Low Intensity Laser Application in Temporomandibular Disorders: A Phase I Double-Blind Study. J Craniomandibular Practice. July 2007;25(3): 186-192

Bjordal J, Johnson M, Rodrigo A, et. al. Short-term Efficacy of Physical Interventions in Osteoarthritic Knee Pain.  A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials.  BMC Musculoskeletal Disorders. 10/02/2007; www.medscape.com.  Accessed June 25, 2009

Crawford F, Thomson C.  Low level laser therapy for nonspecific low-back pain.  Cochrane Database of Systemic Reviews, April 2008, Issue 2 www.mrw.interscience.wiley.com/cochrane/clsysrev.  Accessed June 22, 2009

Gungor A, Dogru S, Cincik H, Erkul E, Poyrazoclu E. Effectiveness of transmeatal low power laser irradiation for chronic tinnitus. J Laryng Otol. 2008; 122: 447-451

Emshoff R, Bosch R, Pümpel E, Schöning H, Strobl H. Low-level laser therapy for treatment of temporomandibular joint pain: a double-blind and placebo-controlled trial. Oral Med Oral Pathol Oral Radiol Endod.2008;105(4):452-6

Stergioulas A, Stergioula M, Aarskog R, et. al. Effects of Low-Level Laser Therapy and Eccentric Exercises in the Treatment of Recreational Athletes with Chronic Achilles Tendinopathy. The American Journal of Sports Medicine. 2008;36(5): 881 – 887

Shooshtari S, Badie V, Taghizadeh S, et. al. The effects of low level laser in clinical outcome and neurophysiological results of carpal tunnel syndrome.  Electromyogr. Clin Neurophysiol. 2008; 48: 229-231

Unlu Z, Tascl S, Tarhan S, Pabuscu Y, Islak S. Comparison of 3 Physical Therapy Modalities for Acute Pain in Lumbar Disc Herniation Measured by Clinical Evaluation and Magnetic Resonance Imaging. J. Manip Phys Thera, Vol 31, No 3;March/April 2008: 191-198

Lawenda B, Mondry T, Johnstone P. Lymphedema: A Primer on the Identification and Management of a Chronic Condition in Oncologic Treatment. CA Cancer J Clin. January/February 2009;59(1): 8-24

Carrasco TG, Guerisoli LD, Guerisoli DM, et al. Evaluation of low intensity laser therapy in myofascial pain syndrome. Cranio. 2009 Oct;27(4):243-247

Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: A systematic review and meta-analysis of randomized placebo or active-treatment controlled trials. Lancet. 2009 Dec;374(9705):1897-1908

Teggi R, Bellini C, Piccioni LO, et al. Transmeatal low-level laser therapy for chronic tinnitus with cochlear dysfunction. Audiol Neurootol. 2009;14(2):115-120

Yeldan I, Cetin E, Ozdincler AR. The effectiveness of low-level laser therapy on shoulder function in subacromial impingement syndrome. Disabil Rehabil. 2009;31(11):935-940

Ay S, Doğan SK, Evcik D. Is low-level laser therapy effective in acute or chronic low back pain? Clin Rheumatol. 2010 Aug;29(8):905-910

Meireles SM, Jones A, Jennings F, et al. Assessment of the effectiveness of low-level laser therapy on the hands of patients with rheumatoid arthritis: A randomized double-blind controlled trial. Clin Rheumatol. 2010 May;29(5):501-509

Low-intensity Pulsed Ultrasound
Magnetotherapy: Historical Background with a Stimulating Future, Critical Reviews in Physical and Rehabilitation Medicine, Vol. 16, No. 2, 2004

Pulsed magnetic field therapy in refractory neuropathic pain secondary to peripheral neuropathy: electrodiagnostic parameters - pilot study, Neurorehabil Neural Repair, Vol 18, No.1, March 2004

Effect of pulsed magnetic field therapy on the level of fatigue in patients with multiple sclerosis - a randomized controlled trial, Multiple Sclerosis, Vol. 11, No.3, June 2005

The Effect of Monochromatic Infrared Energy on Sensation in Patients with Diabetic Peripheral Neuropathy, Diabetes Care, Vol. 28, No. 12, December 2005

Paick JS, Lee SC, Ku JH. More effects of extracorporeal magnetic innervation and terazosin therapy than terazosin therapy lone for non-inflammatory chronic pelvic pain syndrome: a pilot study. Prostate Cancer and Prostate Diseases. 2006;9(3): 261-65 

Warden S, Hons B. Avin K, et. al. Low-Intensity Pulsed Ultrasound Accelerates and a Nonsteroidal Anti-inflammatory Drug Delays Knee Ligament Healing. The American Journal of Sports Medicine. 2006; 34(7): 1094 – 1101

Fernandex M, Watson P, Rowbotham D. Effect of pulsed magnetic field therapy on pain reported by human volunteers in a laboratory model of acute pain. Br J Anaesth. 2007; 99(2):266-269

Ilknur A, Kenan A, Bahar C. Therapeutic effect of pulsed electromagnetic field in conservative treatment of subacromial impingement syndrome. Clin Rheumatol. 2008;26: 1234-1239

Szymborska-Kajanek A; Wystrychowski G, Biniszkiewicq T, Impact of low frequency pulsed magnetic fields on pain intensity, quality of life and sleep disturbances in patients with painful diabetic polyneuropathy. Diabetes Metab 01-Sept-2008;34(4 Pt 1): 349-54

Warden S, Metcalf B, Kiss Z, et. al. Low-intensity pulsed ultrasound for chronic patellar tendinopathy: a randomized, double-blind, placebo-controlled trial. Rheumatology. February 2008; 47: 467-471

Khanna A, Nelmes R, Gougoulias N, Maffulli N, Gray J. The effects of LIPUS on soft-tissue healing: a review of literature. British Medical Bulletin. November 2008:  1-14

Korstjens C, van der Rijt R, Albers G, Semeins C, Klein-Nulend J. Low-intensity pulsed ultrasound affects human articular chondrocytes in vitro. Med Biol Eng Comput. 2008; 46: 1263-1270

Fu S, MPhil, Shum W, et. al. Low-Intensity Pulsed Ultrasound on Tendon Healing. The American Journal of Sports Medicine. 2008;36(9): 1742 – 1749

Weintraub M, Cole S. A Randomized Controlled Trial of the Effects of a Combination of Static and Dynamic Magnetic Fields on Carpal Tunnel Syndrome. Pain Med. 2008;9(5): 493-504

Vasopneumatic Compression
Lavery LA, Murdoch DP, Williams J, Lavery DC. Does anodyne light therapy improve peripheral neuropathy in diabetes? A double-blind, sham-controlled, randomized trial to evaluate monochromatic infrared photoenergy. Diabetes Care. 2008 Feb;31(2):316-21

Franzen-Korzendorfer H, Blackinton M, Rone-Adams S, McCulloch J. The effect of monochromatic infrared energy on transcutaneous oxygen measurements and protective sensation: results of a controlled, double-blind, randomized clinical study. Ostomy Wound Manage. 2008 Jun;54(6):16-31

Devoogdt N, Van Kampen M, Geraerts I, et al. MR. Different physical treatment modalities for lymphedema developing after axillary lymph node dissection for breast cancer: a review. Eur J Obstet Gynecol Reprod Biol. 2010 Mar;149(1):3-9

Vestibular Rehabilitation
Vestibular Rehabilitation of Patients with Vestibular Hypofunction or with Benign Paroxysmal Positional Vertigo, Current Opinions, Neurology, Vol. 13, No. 1, 02/2000

Efficacy of Vestibular Rehabilitation, Otolaryngologic Clinics of North America, Vol. 33, No. 3, 06/2000

Outcome Analysis of Individualized Vestibular Rehabilitation Protocols, The American Journal of Otology, Vol. 21, No. 4, 07/2000

Giray M. Kirazli Y, Karapolat H, et al. Short-term effects of vestibular rehabilitation in patients with chronic unilateral vestibular dysfunction: a randomized controlled study. Arch Phys Med Rehabil. 2009 Aug;90(8):1325-31