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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.
Information in this database was obtained from publicly available materials on the internet, unless otherwise noted. 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 Industrial Relations, Workers' Compensation Division
Contact Information:
Alabama WC Division Directory
News & Updates:
N/A
Other:
Medical Section
Utilization Management and BillScreening
Fee Schedules
Workers' Compensation Act
Therapy Regulations
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | Not applicable | Fee schedule not tied to conversion factor | Not applicable |
| What is the basis of the fee schedule for outpatient therapy services? | Other | 1.075 of 1992 rates of preferred provider reimbursement of largest health plan in the state. Revisions cannot exceed 2.5% increase; Governor can reject in total but not in part. Schedule of fees not required to be published under Administrative Procedures Act |
Schedule of Maximum Fees |
| Are there limits on the number of physical therapy visits allowed? | Yes | Per plan of care signed by physician (must be reviewed every 30 days), pp.1-2 Rule 480-5-5-.19 Physical Therapy / Occupational Therapy / Speech Therapy Services | AL Dept of Industrial Relations: Utlization Management and BIlling Screening |
| Are there limits on payment per visit for outpatient therapy services? | Yes | Described in Rule 480-5-15-.19 | Download the Rule in Adobe PDF |
| Do regulations require use of treatment guidelines? | No | ||
| Is a referral required in order to see a physical therapist? | Yes | "The therapy shall be provided under a current plan of care which is developed by the therapist, a copy of which is sent to and approved by the referring physician and substantiated in the physician's office notes and in the therapist's office notes" | Review Rule 480-5-5-19 in Adobe PDF |
| Can outpatient fees be negotiated above or below the fee schedule? 1 | Yes + / - | Alabama Department of Industrial Relations Administrative Code 480-5-5-.04 Statement of Services, section (3) | Review Rule 480-5-5-04 in Adobe PDF |
| 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? | Yes | PT and PTA specifically referenced in Utilization Management rule | Review Rule 480-5-5-19 in Adobve PDF |
| Are there provider network and/or managed care regulations in place? | No | ||
| Are there regulations that address which fee schedule applies if an injured worker from this state seeks treatment in another state? | Yes | Fee schedule applicable to the provider's state; or mutually negotiated rate; or Alabama WC fee schedule for non-facility providers | Review Rule 480-5-5-37 in Adobe PDF |
| Are there regulations regarding Functional Capacity Evaluations (FCEs)? | Yes | Page 10 rule 480-5-5-19 Follow CARF guidelines | Review Rule 480-5-5-19 in Adobe 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 - No
Exclusive State Fund - No
State Comp Fund (last resort) - No