Printing - FECA-PT2 - National Association of Letter Carriers

(2) If the information received is incomplete or doubt exists about the suitability,
appropriateness, and/or need for the membership, service, or equipment, request
clarification from the attending physician or obtain a second opinion medical examination.
If after weighing the medical evidence the purchase must be denied, advise the claimant by
letter of the denial, the reasons for it, and the alternatives which can be considered.
Provide a formal decision with appeal rights if requested. Copies of the letter approving or
denying the request should be sent to the employing agency and treating physician.
2-0810-16 Physical Therapy
16. Physical Therapy. This paragraph describes how and when the CE may authorize physical therapy
services.
a. In certain accepted claims, the CE should advise claimants that physical therapy (PT) is
authorized if prescribed by the treating physician. Such notice should be sent in all claims with
accepted orthopedic or neurologic conditions. (This notice may be deferred in cases involving brain
and spinal cord injuries, extensive second and third degree burns, and other conditions which have
rendered the claimant bedridden.) If there is any question regarding the appropriateness or
duration of the physical therapy involved, the CE should confer with the RN if the case is under
nurse intervention.
b. Notification may be accomplished via the acceptance letter (Form CA-1008). The CE should
authorize PT for a period of 120 days from the date of injury. Authorization of therapy in excess of
120 days requires additional medical justification and formal approval by the CE. A sample
paragraph for initial acceptance is shown in Exhibit 5.
c. If the accepted condition is severe brain and/or spinal cord injury or disease, widespread
malignancies, severe second or third degree burns, etc., the CE should authorize PT as supported
by medical documentation and should update Case Management screen 34 to show the period
authorized.
d. If further authorization beyond the initial 120-day period is requested, the CE must request
the following medical information, unless already present in file:
(1) Specific modalities, procedures and/or tests and measures to be administered,
detailed by Physicians' Current Procedural Terminology (CPT-4) codes;
(2) Diagnosis for which the therapy is administered;
(3) Specific functional deficits which are to be treated, including a description of how
these deficits affect the claimant's physical activities;
(4) Expected duration and frequency of treatment; and
(5) Specific functional goals of the additional therapy.
If this medical information is already present in the file, the CE should review it and evaluate the
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