Utilization Review Checklist
Postoperative Rehabilitation — Visit Allowances
Derived from the 8 CCR § 9792.24.3 — Postoperative Rehabilitation Guidelines, edition date not confirmed, as adopted into the California MTUS 1 December 2017. CPT 97110, 97112, 97116, 97140, 97530, 98940. ICD-10 Z47.1, Z47.89, Z48.89.
Draft — not reviewed or approved by COA. Prepared by Rette from the ACOEM guideline named above. This is not a COA document and does not reproduce COA’s own checklists.
Procedures — the guideline treats each separately
Postoperative rehabilitation visits — physical therapy, occupational therapy or chiropractic
Recommended.
Strength of Evidence — Regulation — 8 CCR § 9792.24.3
Indications
Required
The operation and its date are stated, and whether the request falls within the post-operative period
“The post-operative rehabilitation treatment recommendations apply to visits during the post-operative period only and to surgeries as defined in those guidelines.”
Prior Treatment
Required
The Clinical Topics, Chronic Pain or Opioid guideline that sets the allowance for this operation is identified
“Guidance for postoperative rehabilitation treatment and evaluation are contained in the Clinical Topics guidelines, and/or Chronic Pain Guideline and/or Opioid Guideline.”
Dose, Duration and Discontinuation
Required
After the post-operative period, treatment reverts to the 24-visit limitation for chiropractic, occupational therapy and physical therapy under Labor Code § 4604.5(c)(1) — at least 24
“At the conclusion of the post-operative period, treatment reverts back to the applicable 24-visit limitation for chiropractic, occupational therapy, and physical therapy pursuant to Labor Code section 4604.5(c)(1).”
Two separate periods, and conflating them is the commonest error. DURING the post-operative period, the allowance comes from the relevant Clinical Topics chapter for the operation performed. AFTER it, the 24-visit limitation under Labor Code § 4604.5(c)(1) applies. State which period the request falls in and cite the chapter that sets the allowance for the operation.