CommercialCoverageHigh impact
Physical Therapy (BSC8.03)
Blue Shield of California·CA · Physical Therapy, PM&R (Physical Medicine & Rehab), Orthopedics +1 more·Medical Policy
Effective date
Jun 1, 2026
We identified it
Jun 1, 2026
Summary
Blue Shield of California has updated their Physical Therapy policy (BSC8.03) effective June 1, 2026, establishing comprehensive medical necessity criteria for rehabilitative, maintenance, and habilitative PT services. The policy requires specific documentation of functional improvement, qualified practitioner delivery, and excludes services like back school, work hardening programs, and general fitness activities.
Action Required
Before June 1, 2026: Physical therapy providers must update documentation templates to include all required elements: objective verification of progressive functional improvement over time, individualized treatment programs, quantifiable and attainable treatment goals, and clinical justification for service initiation/continuation. Update billing system to flag excluded services (back school, work hardening, vocational rehab, wellness programs) as non-covered. Train staff on new medical necessity criteria requiring potential for improvement, reasonable timeframes, and skilled practitioner necessity.