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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 and Employment, Division of Workers' Compensation
Contact information:
Colorado WC Contacts (In particular, Medical Cost Containment)
News & Updates:
What's New in the Division of Workers' Compensation
Other:
Medical Providers Webpage
Physical Medicine and Rehabilitation
Rules of Procedure – General
Medical Fee Schedule
Medical Treatment Guidelines
Therapy Regulations
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | $5.90 | See Rule 18-4 | Rule 18 Medical Fee Schedule |
| What is the basis of the fee schedule for outpatient therapy services? | RVP | See Rule 18-1 | Rule 18 Medical Fee Schedule |
| Are there limits on the number of physical therapy visits allowed? | Yes | Prior authorization required when service exceeds recommended limits in Medical Treatment Guidelines (See Rule 18-5(H)(3)) | Rule 18 Medical Fee Schedule |
| Are there limits on payment per visit for outpatient therapy services? | Yes | 2 modality limit; 60 min. procedure limit w/o prior authorization; WC and WH have limits (2 and 6 hours) See Rule 18-5(H) |
Rule 18 Medical Fee Schedule |
| Do regulations require use of treatment guidelines? | Yes | State-specific: multiple conditions | Rule 17 Medical Treatment Guidelines |
| Is a referral required in order to see a physical therapist? | Yes | All nonphysician providers must have a referral from an authorized treating physician. DWC 7CCR1101-3 Rules of Procedure See Rule 16-5(A)(4)(b) |
Rule 16 Utilization Standards |
| Can outpatient fees be negotiated above or below the fee schedule? 1 | Yes | Payer must furnish specifics regarding the discount or pay in full See Rule 16-11(A)(4) |
Rule 16 Utilization Standards |
| Can the injured worker be charged for any claim-related services? | Unknown | ||
| Are there workers' compensation regulations about who can provide services under the direction and supervision of a physical therapist? | Unknown | ||
| Are there provider network and/or managed care regulations in place? | Yes | Employer/insurer is legally responsible for rule compliance, even if acting through an agent See Rule 16-6(A) |
Rule 16 Utilization Standards |
| 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 | Rule 18- 5(H)(8) | Rule 18 Medical Fee Schedule |
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 - Yes
Exclusive State Fund - No
State Comp Fund (last resort) - No