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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.
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Workers' Compensation Practice and Procedure (Rules)
Therapy Regulations
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | No reported. | Fee schedule not tied to conversion factor | https://www.azica.gov/2017-arizona-physicians-fee-schedule |
| What is the basis of the fee schedule for outpatient therapy services? | Other | 75th %ile of surveyed values from several states (CO, NV, NM, NC, OR, UT, WA) | Designing workers' compensation medical fee schedules. (WCRI report WC-12-19, June 2012) |
| Are there limits on the number of physical therapy visits allowed? | No | May be subject to vendor review | Workers' compensation medical cost containment: A national inventory, 2011 (WCRI report WC-11-35, April 2011) |
| Are there limits on payment per visit for outpatient therapy services? | Yes | Cascading modality (97010-97139) paid at 100%/50%/25%/10%/5%; procedures paid at 100%; 60 min therapeutic procedures-more must be approved | https://www.azica.gov/2017-arizona-physicians-fee-schedule |
| Do regulations require use of treatment guidelines? | No | 5/24/12 Note: AZ Legislature recently called upon the Industrial Commission of Arizona to adopt guidelines. | |
| Is a referral required in order to see a physical therapist? | No | PT not recognized as a treating provider, but not subject to referral. FCE requires prior authorization |
Workers' compensation medical cost containment: A national inventory, 2011 (WCRI report WC-11-35, April 2011) |
| 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? | No | Administrative Rule AAC R20-5-117.B. "A claimant shall not be responsible to pay any disputed amounts between the medical provider and the carrier, self-insured employer, or special fund division (page 11) | https://www.azica.gov/fee-schedule-frequently-asked-questions |
| Are there workers' compensation regulations about who can provide services under the direction and supervision of a physical therapist? | No | Default to state practice act | |
| 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? | No | ||
| Are there regulations regarding Functional Capacity Evaluations (FCEs)? | Yes | Requires prior authorization |
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