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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).
The agency certifies that legal counsel has
reviewed the adoption and found it to be a valid exercise of the agency's
legal authority.
Filed with the Office
of the Secretary of State on June 17, 2016
TRD-201603100 Nicholas Canaday III
General Counsel
Texas Department of Insurance, Workers' Compensation Division
Effective date: July 7, 2016
Proposal publication date: March 18, 2016
For further information, please call: (512) 804-4703
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