By using this site, you are consenting to our use of cookies. To find out more visit our privacy policy.
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 Regulations Bureau , Employment Relations Division
Contact Information:
Workers' Compensation Administration(MT Department of Labor & Industry)
MT Worker's Compensation Management Bureau
News & Updates:
MT Workers' Compensation Administration (Scroll down to "Featured News" and "Current Events")
Subscribe up for e-mail updates from Employment Relations Division (ERD)
Other:
Administrative Rules
Montana Code Annotated (Workers' Compensation)
Fee Guidelines and Information
Nonfacility Fee Schedule
Telehealth and Workers' Compensation in MT
Medical Regulations
Montana Utilization and Treatment Guidelines
Clinical Guidance to Optimize Work Participation After Injury or Illness: The Role of Physical Therapists
Therapy Regulations
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | $ 64.84 | 24.29.1538 (2)(I) | https://rules.mt.gov/gateway/RuleNo.asp?RN=24%2E29%2E1538 |
| What is the basis of the fee schedule for outpatient therapy services? | RBRVS | Montana Administrative Register Notice 24-29-225 | https://rules.mt.gov/gateway/ShowNoticeFile.asp?TID=10 |
| Are there limits on the number of physical therapy visits allowed? | Yes | Based on treatment guidelines | https://mtguidelines.mt.gov/?pk_vid=115cd691130199771636311251eb625c |
| Are there limits on payment per visit for outpatient therapy services? | Yes | Varying limits on units for modalities and procedures, listed in utilization rules |
https://leg.mt.gov/bills/mca/title_0390/chapter_0710/part_0070/section_0040/0390-0710-0070-0040.html https://leg.mt.gov/bills/mca/title_0390/chapter_0710/part_0110/section_0010/0390-0710-0110-0010.html |
| Do regulations require use of treatment guidelines? | Yes | State-specific; effective 7/1/11 | https://rules.mt.gov/gateway/RuleNo.asp?RN=24%2E29%2E1611 https://mtguidelines.mt.gov/?pk_vid=115cd691130199771636311251eb625c |
| Is a referral required in order to see a physical therapist? | Yes | Required for payment |
https://leg.mt.gov/bills/mca/title_0390/chapter_0710/part_0110/section_0010/0390-0710-0110-0010.html https://leg.mt.gov/bills/mca/title_0390/chapter_0710/part_0010/section_0160/0390-0710-0010-0160.html(MCA 39-7-116 section 42) https://rules.mt.gov/gateway/ruleno.asp?RN=24.29.1621(Prior authorization)
|
| Can outpatient fees be negotiated above or below the fee schedule? 1 | 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 the injured worker be charged for any claim-related services? | Unknown | https://leg.mt.gov/bills/mca/title_0390/chapter_0710/part_0070/section_0040/0390-0710-0070-0040.html | |
| Are there workers' compensation regulations about who can provide services under the direction and supervision of a physical therapist? | No | No specific language specific to worker’s compensation. General supervision regulations exist for MT. |
https://leg.mt.gov/bills/mca/title_0370/chapter_0110/part_0010/section_0050/0370-0110-0010-0050.html https://rules.mt.gov/gateway/RuleNo.asp?RN=24%2E177%2E405 |
| Are there provider network and/or managed care regulations in place? | Yes | MCA 39-71-1101-1106 and MAR 24.29.2301-2379 | https://www.leg.mt.gov/bills/mca/title_0390/chapter_0710/part_0110/sections_index.html www.mtrules.org/gateway/Subchapterhome.asp?scn=24%2E29%2E23 |
| Are there regulations that address which fee schedule applies if an injured worker from this state seeks treatment in another state? | Unknown | MT fee schedule applies if services are delivered out of state for a worker injured/covered under Montana workers' compensation system |
https://leg.mt.gov/bills/mca/title_0390/chapter_0710/part_0040/section_0420/0390-0710-0040-0420.html https://leg.mt.gov/bills/mca/title_0390/chapter_0710/part_0010/section_0180/0390-0710-0010-0180.html https://rules.mt.gov/gateway/RuleNo.asp?RN=24%2E16%2E503 |
| Are there regulations regarding Functional Capacity Evaluations (FCEs)? | No |
https://mtguidelines.mt.gov/?pk_vid=115cd691130199771636311251eb625c FCE Guidelines: https://www.orthopt.org/uploads/content_files/files/Occupational_Hlth_PT_Evaluating_Functional_Capacity_040610_2_.pdf Current Concepts: https://www.orthopt.org/uploads/content_files/files/2018_Current_Concepts_in_OH_PT_FCE_06_20_18_FINAL%281%29.pdf |
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) - Yes