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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 Court (WCC)
Contact Information:
WCC Contacts
News & Updates:
What's New
Other:
Medical Services
Medical Publications
Schedule of Medical and Hospital Fees
Treatment Guidelines
Therapy Regulations
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | Not reported | 2012 Schedule of Medical and Hospital Fees, page 144 | www.owcc.state.ok.us/fee_schedule.htm |
| What is the basis of the fee schedule for outpatient therapy services? | RBRVS | 2012 Schedule of Hospital and Medical Fees, page 1 | www.owcc.state.ok.us/fee_schedule.htm |
| Are there limits on the number of physical therapy visits allowed? | Yes | 2012 Schedule of Hospital and Medical Fees. Physical medicine ground rules, pp. 139-141; treatment exceeding adopted medical treatment guidelines requires prior authorization, or 18 visits If there is a conflict, MTG governs |
www.owcc.state.ok.us/fee_schedule.htm |
| Are there limits on payment per visit for outpatient therapy services? | Yes | 2012 Schedule of Hospital and Medical Fees. Page 140 – 4 units per day; 6 if multiple regions; except FCE. | www.owcc.state.ok.us/fee_schedule.htm |
| Do regulations require use of treatment guidelines? | Yes | Effective 3/1/12 ODG and Oklahoma Treatment Guidelines, p. 10 of 2012 Schedule of Hospital and Medical Fees | www.owcc.state.ok.us/fee_schedule.htm www.owcc.state.ok.us/guidelines.htm |
| Is a referral required in order to see a physical therapist? | Yes | 2012 Schedule of Hospital and Medical Fees. Physical Medicine Ground Rule 2 | www.owcc.state.ok.us/fee_schedule.htm |
| Can outpatient fees be negotiated above or below the fee schedule? 1 | Yes + / - | Schedule of fees does not apply to services under a contract (Foreword, section 2 of 2012 Schedule of Hospital and Medical Fees) | www.owcc.state.ok.us/fee_schedule.htm |
| 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? | Yes | Per Physical Medicine Ground Rules, 2a) A licensed physical therapist assistant under the direct clinical on-site supervision of a licensed physical therapist or under the general supervision of a licensed physical therapist, as provided in the rules of the State Board of Medical Licensure and Supervision | www.owcc.state.ok.us/fee_schedule.htm |
| Are there provider network and/or managed care regulations in place? | Yes | Managed care is regulated by Department of Health | www.ok.gov/health/Protective_Health/Health_Resources_Development_Service/Managed_Care_Systems/ (See: Laws and Rule) |
| Are there regulations that address which fee schedule applies if an injured worker from this state seeks treatment in another state? | No | ||
| Are there regulations regarding Functional Capacity Evaluations (FCEs)? | Yes | Physical Medicine Ground Rules (4)(b) | www.owcc.state.ok.us/fee_schedule.htm |
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