Functional Capacity Evaluation vs. Impairment Rating

FCE vs. IR - Do you know the difference?
Man pushing a heavy stack of cargo

Often, when a functional capacity evaluation (FCE) is ordered for an injured worker, an impairment rating (IR) is also requested. Impairment ratings are a relatively easy way to expand clinical services and increase your value to referral sources, yet they are often overlooked. Many clinicians do not fully understand the difference between FCEs and IR. Unknowns can be intimidating, but let’s shed some light on this lesser-known service so you can understand it and decide whether adding impairment ratings to your suite of clinic services makes sense.

First, let’s start with some essential explanations of FCEs and IR.


Functional Capacity Evaluation (FCE) is a test to determine a patient’s level of function as it relates to work. However, other instrumental activities of daily living that support work performance may also be assessed. A comprehensive FCE should provide overall work abilities and tolerances for full-time work and will cover all work demands defined by the US Department of Labor in the Dictionary of Occupational Titles (DOT). A well-designed FCE tests strength using dynamic function rather than isometric strength testing. The well-designed FCE involves an objective scoring system for determining an accurate level of work and projecting client abilities for full-time work.

Click here to learn more about a well-designed FCE. 


By contrast, an impairment rating is used to determine a patient’s level of impairment. A percent of limb or whole-body impairment is assigned when the evaluation is performed on a patient. These impairment percentages are used in settling workers’ compensation cases. The American Medical Association (AMA) has developed a prescribed methodology for performing impairment ratings. This methodology is published in The AMA’s Guides to the Evaluation of Permanent Impairment.

The “AMA Guide” covers the process of determining impairment in all body systems. However, the musculoskeletal and neurological impairments sections are the most relevant to physical and occupational therapists. The typical extremity musculoskeletal impairment involves medical history (including related surgical procedures), diagnostic imaging, and goniometric range of motion measures and then using tables and graphs in the “AMA Guide” to determine the percent impairment.


For FCEs and IRs, each state varies in who can perform these services.

Physical therapists or occupational therapists most often perform FCEs. However, many states allow other clinicians, such as PTAs, COTAs, ATCs, or Ex Phys, to perform FCEs in conjunction with a therapist.

Impairment ratings are a bit different. In some states, only physicians are allowed to perform them. However, many physicians are reluctant to perform IRs as they can be time-consuming from the physician’s perspective. Therefore, many orthopedic or neurosurgeons like to outsource this service to physical and occupational therapists. In these cases, therapists make the range of motion measurements and assign the impairment percentages based on the AMA Guides, and the physician reviews and signs off on the report.


If you care about your patients, your license, and your reputation, the answer is YES; you need training.

You could pull a bit of FCE testing protocol from here and a bit from there, slap it together, and call it a defensible, functional test. While that might get the job done, is it an accurate test? Is it fair and objective to truly determine a person’s physical abilities as they relate to work? Is it reliable, valid, and legally defensible? A lot is riding on these assessments. They not only affect pocketbooks but deeply affect the social fabric of the worker’s life. You want an FCE system with proven validity, one supported by peer-reviewed, published research, one that provides practical, in-depth training and post-training customer support.

Regarding IRs, the AMA has multiple editions of their Guide to the Evaluation of Permanent Impairments (each state determines which Guide they use). It is certainly possible to open up the “AMA Guide” and teach yourself how to do impairment ratings. However, the time and energy you expend and the confusion that results may not be worth the money you would spend by going to a course. The IR procedures are not rocket science, but they can be somewhat confusing based on reading the text alone.


Impairment ratings do not require expensive equipment or software, so entrance into this sub-specialty is relatively inexpensive.

Impairment ratings are often needed and requested in conjunction with an FCE. Therefore, performing them allows you to meet your referral source’s needs for resolving workers’ compensation cases rather than referring out what could be an easy source of income.

Impairment ratings are typically billed using the same CPT code as you would for an FCE (97750 in most states). For an average evaluation, clinicians can bill 4-6 units depending on how complicated the patient’s disability may be. Worker’s compensation services are often reimbursed at a higher rate than other services, so adding IR to your suite or clinic offerings makes sense.

If you are interested in expanding your work comp playbook with either FCEs or impairment ratings, as well as providing a serious stimulus to your payor mix, let’s start a conversation to explore how this might fit into your practice.

Deborah Lechner

Deborah Lechner

Deborah Lechner, ErgoScience President, combines an extensive research background with 25-plus years of clinical experience. Under her leadership, ErgoScience continues to use the science of work to improve workplace safety, productivity and profitability.
ErgoScience Workplace Injury Prevention Logo


We'd Love to Chat!

Our goal is to help people in the best way possible. this is a basic principle in every case and cause for success. contact us today for a free consultation.