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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:
Department of
Financial Services, Division of Workers' Compensation
Contact Information:
850/413-1600 or
800/742-2214
Email Florida DWC
News & Updates:
Sign up for e-mail notifications
Other:
Office of Medical Services
Reimbursement Manuals
Therapy Regulations
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | Not applicable | Publishes schedule of Maximum Reimbursable Amounts by locality (part A and part B) | https://www.myfloridacfo.com/division/wc/ |
| What is the basis of the fee schedule for outpatient therapy services? | Other | Maximum fee schedules provided | https://www.myfloridacfo.com/Division/WC/PublicationsFormsManualsReports/Manuals/Default.htm |
| Are there limits on the number of physical therapy visits allowed? | Yes | Prior auth required for all services with some exceptions noted in Section VIII.B.1.(a)(1-2) | https://www.myfloridacfo.com/division/wc/ |
| Are there limits on payment per visit for outpatient therapy services? | Yes | 4 units mod/proc per day; Section VIII.B.5. | https://www.myfloridacfo.com/division/wc/ |
| Do regulations require use of treatment guidelines? | Yes | Practice parameters adopted by AHRQ in effect on January 1, 2003 ยง440.13(15) Florida statute | http://www.flsenate.gov/Laws/Statutes/2010/440.13 |
| Is a referral required in order to see a physical therapist? | Yes | Section VIII.A.1 Healthcare Provider Reimbursement Manual | http://www.myfloridacfo.com/wc/pdf/2008HCPRM.pdf |
| 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) |
| Are there workers' compensation regulations about who can provide services under the direction and supervision of a physical therapist? | Yes | FL statute allows $10 copay for services post MMI (sub-subsection 440.13(14)PAYMENT OF MEDICAL FEES c) | https://www.myfloridacfo.com/Division/WC/PublicationsFormsManualsReports/Manuals/Default.htm |
| 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 | FS 440.134 and FAC 69L-31.015 | http://www.flsenate.gov/Laws/Statutes/2010/440.134 |
| Are there regulations regarding Functional Capacity Evaluations (FCEs)? | Yes | Must bill in accordance with rule 69L-7.602 per Provider Reimbursement Manual Section II C Billing | |
| Are there workers' compensation regulations about who can provide services under the direction and supervision of a physical therapist? | Yes | Rule 69L-7.020, F.A.C., Chapter 2. Page 32 Health Care Provider Reimbursement Manual | https://www.myfloridacfo.com/Division/WC/PublicationsFormsManualsReports/Manuals/Default.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 - No
Exclusive State Fund - No
State Comp Fund (last resort) - No