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Therapy (Physical/Occupational/General Rehabilitation)

Document Title Document Type Document Size Effective Date
Acupuncture - (CPG024)  PDF 637kB 04/15/2025
Axial/Spinal Decompression Therapy/Mechanical Traction (Provided in a Clinic Setting) - (CPG275)  PDF 414kB 04/15/2025
Biofeedback - (CPG294)  PDF 675kB 11/15/2024
Cardiac Rehabilitation (Phase II Outpatient) - (0073)  PDF 403kB 06/15/2024
Chiropractic Care - (CPG278)  PDF 524kB 12/15/2024
Cognitive Rehabilitation - (CPG270)  PDF 522kB 07/15/2024
Complex Lymphedema Therapy (Complete Decongestive Therapy) - (CPG157)  PDF 463kB 05/15/2024
Electric Stimulation for Pain, Swelling and Function in a Clinic Setting - (CPG272)  PDF 968kB 08/15/2024
Electrodiagnostic Testing (EMG/NCV) - (CPG129)  PDF 928kB 09/15/2024
Home Traction Devices - Cervical and Lumbar - (CPG265)  PDF 338kB 04/15/2025
Low-Level Laser and High-Power Laser Therapy - (CPG030)  PDF 670kB 03/15/2025
Occupational Therapy - (CPG155)  PDF 576kB 12/15/2024
Patient Assessments: Medical Necessity Decision Assist Guideline for Evaluations and Re-evaluations - (CPG111)  PDF 378kB 07/15/2024
Physical Performance Test or Measurement - (CPG295)  PDF 324kB 11/15/2024
Physical Therapy - (CPG135)  PDF 613kB 12/15/2024
Sensory and Auditory Integration Therapy - Facilitated Communication - (CPG149)  PDF 407kB 06/15/2024
Spinal Ultrasound - (CPG038)  PDF 315kB 09/15/2024
Strapping and Taping - (CPG143)  PDF 688kB 5/15/2024
May 06, 2025