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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:
Workers' Compensation Commission (WCC)
Contact Information:
South Carolina WC Contacts
Insurance and Medical Services Contacts
News & Updates:
See "What's New" on WCC Website
Other:
Medical Services Division (Order Medical Services Provider Manual here )
Regulations (See: Article 13)
Therapy Regulations
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | Not reported | Fee schedule available for purchase, $75. Order from WCC | http://www.wcc.sc.gov/insurance/Pages/MedicalServicesDivision.aspx http://www.wcc.sc.gov/Documents/IMS/MSPM%20Brochure.pdf |
| What is the basis of the fee schedule for outpatient therapy services? | RBRVS | Article 13, SC code of regulations 67-1302. Maximum Allowable Payments to Medical Practitioners | http://www.scstatehouse.gov/coderegs/c067.php |
| Are there limits on the number of physical therapy visits allowed? | Yes | Services require prior authorization per section 7 of Medical Services Provider Manual, page 556; manual ordered from WCC | http://www.wcc.sc.gov/Documents/IMS/MSPM%20Brochure.pdf |
| Are there limits on payment per visit for outpatient therapy services? | No | ||
| Do regulations require use of treatment guidelines? | No | ||
| Is a referral required in order to see a physical therapist? | Yes | Chapter 23, general policy Medical Services Provider Manual | http://www.wcc.sc.gov/Documents/IMS/MSPM%20Brochure.pdf |
| Can outpatient fees be negotiated above or below the fee schedule? 1 | Yes - | Per WCRI, can only be negotiated lower than published rates, but no citation noted | Workers' compensation medical cost containment: A national inventory, 2011 (WCRI report WC-11-35, April 2011) |
| Can the injured worker be charged for any claim-related services? | 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 | Regulation 67-1307/1308 | http://www.scstatehouse.gov/coderegs/67.php |
| Are there regulations that address which fee schedule applies if an injured worker from this state seeks treatment in another state? | No | South Carolina fee schedule applies | |
| Are there regulations regarding Functional Capacity Evaluations (FCEs)? | Yes | South Carolina Medical Fee Schedule Section 7 - Physical Medicine |
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