Physical Therapy - (CPG135)

Cigna covers medically necessary rehabilitative and habilitative physical therapy (e.g., PT evaluation, therapeutic exercise, neuromuscular re‑education, aquatic therapy, gait training, E‑stim, traction, hydrotherapy, ultrasound, and hand orthotics when criteria are met) but excludes/considers experimental many modalities (e.g., vasopneumatic devices, dry needling, elastic/kinesio tape, vertebral axial decompression), disallows massage unless part of covered PT/OT/chiropractic, and limits outpatient PT to 4 timed units (one hour) per provider per date of service. Coverage requires services be provided by qualified providers with objective evidence of progressive improvement and complete contemporaneous documentation (initial evaluation, quantitative plan of care, daily timed treatment notes, progress reports, re‑evaluations, discharge); custom hand orthoses additionally require a supporting exam within six months and meeting specific clinical criteria.

"Physical therapy evaluation is medically necessary for the assessment of a physical impairment."