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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:
State Board of Workers' Compensation (SBWC)
Contact information:
Georgia SBWC Contacts
News & Updates:
Georgia SBWC Website
Scroll down to "News"
Other:
Procedure Manuals
Fee Schedules (Note: Managed Care & Rehabilitation = catastrophic injuries)
Best Practices
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | Not reported | Fee schedule only available for purchase | http://sbwc.georgia.gov/medical |
| What is the basis of the fee schedule for outpatient therapy services? | Other | State developed fee schedule for Max Allowable Reimbursement ยง 34-9-205 | http://www.lexisnexis.com/hottopics/gacode/Default.asp |
| Are there limits on the number of physical therapy visits allowed? | No | Procedure Manual, Chapter 7 Medical Benefits, Section F | http://sbwc.georgia.gov/sites/sbwc.georgia.gov/files/related_files/site_page/ProcedureManual2011_1.pdf |
| Are there limits on payment per visit for outpatient therapy services? | Yes | 4 units per visit (maximum of 2 modalities); with exceptions for catastrophic injuries, WH/WC, and FCE | http://sbwc.georgia.gov/sites/sbwc.georgia.gov/files/imported/SBWC/Files/FCE_Amendment5_01_09.pdf |
| Do regulations require use of treatment guidelines? | No | ||
| Is a referral required in order to see a physical therapist? | No | PT recognized as treating provider, not subject to referral | 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 | ||
| Are there workers' compensation regulations about who can provide services under the direction and supervision of a physical therapist? | No | ||
| Are there provider network and/or managed care regulations in place? | Yes | OCGA 34-9-208 (Article 6, Part 1), and Rule 208 | http://www.lexisnexis.com/hottopics/gacode/Default.asphttp://sbwc.georgia.gov/sites/sbwc.georgia.gov/files/Rules2012.pdf |
| 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 | Amendment to The Georgia Workers' Compensation Medical Fee Schedule Sections IV and XI | http://sbwc.georgia.gov/sites/sbwc.georgia.gov/files/imported/SBWC/Files/FCE_Amendment5_01_09.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