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This summary sets forth various workers' compensation regulations regarding outpatient physical therapy services. The Workers' Compensation State Regulations resource may serve as a tool to assist in locating regulations. Please send database comments and corrections to advocacy@apta.org.
To the extent an individual or entity wishes to rely upon information contained in this resource, such reliance should be based upon an independent legal review and analysis of applicable law. This resource was prepared for informational purposes only and is not offered or intended, nor should it be relied upon, for legal advice for any specific set of circumstances. Additional legal doctrines, federal and state statutes, and case law not set forth herein may apply to your situation and such laws, rules and regulations can vary from state to state. You should consult with your own attorney to obtain specific legal advice on your particular facts and circumstances and applicable laws, rules, and regulations.
Key Resources/Links
Agency:
Department of Labor & Industry, Workers' Compensation
Contact Information: Minnesota WC Contacts
News & Updates: Compact Newsletter
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Other:Medical Benefits
Fees for Medical Services (See: 5221.4050 and 5221.4051 for physical medicine)
Treatment Parameters
Therapy Regulations
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | * $52.35 | 5221.4020 Determining fee schedule payment limits (B)(1)(c) * $54.41 eff. 10/1/12 per August 2012 newsletter |
https://www.revisor.mn.gov/rules/?id=5221.4020 |
| What is the basis of the fee schedule for outpatient therapy services? | RBRVS | 5221.4005 Instructions for application of fee schedule | https://www.revisor.mn.gov/rules/?id=5221.4005 |
| Are there limits on the number of physical therapy visits allowed? | Yes | Passive treatment is limited to 12 weeks, with provision for additional treatment under specified circumstances Per chapter 5221 Fees for Medical services, sections 6200-6600 | https://www.revisor.mn.gov/rules/?id=5221 |
| Are there limits on payment per visit for outpatient therapy services? | Yes | 97012-97039: 100% highest RVU, 75% all others | https://www.revisor.mn.gov/rules/?id=5221.4051 |
| Do regulations require use of treatment guidelines? | Yes | State specific; Per chapter 5221 Fees for Medical services, sections 6200-6600 | https://www.revisor.mn.gov/rules/?id=5221 |
| Is a referral required in order to see a physical therapist? | Yes + / - | WCRI report indicates can be negotiated above or below the published rate, but no citation located | Workers' compensation medical cost containment: A national inventory, 2011 (WCRI report WC-11-35, April 2011) |
| Can outpatient fees be negotiated above or below the fee schedule? 1 | No | ||
| Are there workers' compensation regulations about who can provide services under the direction and supervision of a physical therapist? | No | ||
| Are there provider network and/or managed care regulations in place? | Yes | Statute 176.1351; Rules part 5218 | https://www.revisor.mn.gov/statutes/?id=176.1351 https://www.revisor.mn.gov/rules/?id=5218 |
| Are there regulations that address which fee schedule applies if an injured worker from this state seeks treatment in another state? | Unknown | ||
| Are there regulations regarding Functional Capacity Evaluations (FCEs)? | Yes | LBP - 5221.6200 Subpart 1 (I) Neck Pain - 5221.6205 Subpart 1 (I) Thoracic Back Pain - 5221.6210 Subpart 1 (I) Upper Extremity Disorders - 5221.6300 Subpart 1 (J) Use CPT 97750 - 5221.4050 Subpart 3 (D) |
https://www.revisor.mn.gov/rules/pdf/5221/2021-10-19%2012:36:09+00:00 https://www.revisor.mn.gov/rules/?id=5221.4050 |
1 While some states use a mandatory fee schedule, many states have provisions for fees to be negotiated above or below the published fee schedule. "Yes + / - " indicates that fees can be negotiated above or below the fee schedule. "Yes -" indicates that fees can only be negotiated below the fee schedule.
The following payer types conduct business in this state.
Private Carriers - Yes
Self-insured Employers or Groups - Yes
Competitive State Fund - No
Exclusive State Fund - No
State Comp Fund (last resort) - Yes