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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:
ConnecticutWorkers' Compensation Commission
Contact Information:
Connecticut WC E-mail Contacts Phone and Fax Contacts
Fee Schedule questions: Marilou Lang 860/493-1559
Marilou.lang@ct.gov
News & Updates:
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News Page
Other: Fee Schedule Regulations
Fee Schedule: Order from Ingenix at 800/464-3649
Therapy Regulations
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | Not applicable | Admin. Regulation Sec. 31-280-3(b)(3); 74% | http://wcc.state.ct.us/law/wc-regs/31-280-3.htm |
| What is the basis of the fee schedule for outpatient therapy services? | Other | Admin. Regulation Sec. 31-280-3(b)(2) Database of statewide charges | http://wcc.state.ct.us/law/wc-regs/31-280-3.htm |
| Are there limits on the number of physical therapy visits allowed? | Yes | Prior auth required for services beyond established WCC medical protocols (p. 3 of 13) | http://wcc.state.ct.us/download/acrobat/payor-provider-guidelines.pdf |
| Are there limits on payment per visit for outpatient therapy services? | Yes | $125 per day | p. 273 of fee schedule (Physical Medicine section), available through Ingenix |
| Do regulations require use of treatment guidelines? | Yes | State-specific: Cervical, lumbar, arm, hand and leg musculoligamentous injury | http://wcc.state.ct.us/download/acrobat/protocols.pdf |
| Is a referral required in order to see a physical therapist? | Yes | Must be referred by treating physician | 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 | Admin. Regulation Sec. 31-280-3(b)(4) - except when practitioner and payer have entered into a specific written agreement providing otherwise | http://wcc.state.ct.us/law/wc-regs/31-280-3.htm |
| 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, PTA only. Fee schedule lists PT, PTA, OT, OTA, MD, Chiro as physical medicine providers | pg 273 of Official CT Workers' Compensation Fee Schedule, available through Ingenix |
| Are there provider network and/or managed care regulations in place? | Yes | CGS 31-279 and Admin Regs 31-279-10 | http://wcc.state.ct.us/law/wc-act/2009/31-279.htm http://wcc.state.ct.us/law/wc-regs/31-279-10.htm |
| 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 | Written authorization required | http://wcc.state.ct.us/download/acrobat/payor-provider-guidelines.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