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  4. Physical Medicine

Physical Medicine

Physical Medicine Coverage

 

 

Clovis Unified School District is contracted with PhysMetrics to provide its employees, covered dependents, and retirees covered under the Plan with physical medicine services, such as physical therapy, occupational therapy, and chiropractic care therapy benefits.

For detailed information regarding covered services, please click the link for the Schedule of Benefits located under Resources.

Member Cost Share

Physical & Occupational Therapies

Participating Provider

$25 Copay Per Visit

Non-Participating Provider

50% of the network contract rate after any applicable deductible

Visit Limitations

Any treatment involving more than 10 visits MUST have all additional visits preauthorized by the treating provider

Chiropractics

Participating Provider

$25 Copay Per Visit

Non-Participating Provider

The Plan does NOT cover treatment provided by an out-of-network chiropractic provider

Visit Limitations

The Plan covers a maximum of 24 office visits per plan year & up to 10 office visits maximum per month

    • Diagnostic scanning, including but not limited to MRIs, CAT scans, x-rays, etc., must be precertified by PhysMetrics & referred out to a CUSD contracted imaging provider & are not reimbursed to the chiropractor
    • Massage therapy is not a covered benefit

     

    Written precertification is required for the following services before any claims will be paid.  Please call toll-free at 877-519-8839 for precertification for the following services:

    • Treatment for Minor Dependents (15 years of age or younger) must be precertified by PhyMetrics. In the case of an emergency or where authorization was unable to be obtained on the first visit, ONLY the first visit will be covered.
    • Treatment involving more than (12) visits during the benefit year. After the 12th visit, all services must be precertified by PhysMetrics.
    • Additional CPT Codes may require precertification as set forth in the provider fee schedule.

Resources