Physical Performance Test or Measurement - (CPG295)

Cigna covers Functional Capacity Evaluations (including CPT 97750) and other physical performance tests when medically necessary but excludes vocational/work‑hardening programs and deems quantitative isokinetic muscle‑testing devices (e.g., MedX, Biodex) and educational/training codes experimental/not medically necessary. Coverage requires a written referral with clearly defined return‑to‑work goals, evaluation by a qualified licensed evaluator with pre‑test screening and informed consent, comparison of results to standardized norms, detailed time‑based documentation (prep/testing/post‑instructions), and adherence to timing/frequency limits (generally ≥3 months post‑injury, 2–4 hours per date of service, typically one FCE per 12 months unless objectively justified).

"Functional Capacity Evaluation (FCE) is considered medically necessary when ALL of the following criteria are met: A written referral (from physician, carrier, or employer) is forwarded to the eval..."