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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.
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Medical Services and Cost Containment home
Physicians Fee Schedule
Therapy Regulations
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | No report | Fee schedule must be purchased | |
| What is the basis of the fee schedule for outpatient therapy services? | State Relative Value | Uses RBRVS and RVP | Workers’ Compensation Medical Cost Containment: A National Inventory, 2021. March 2021. WC-21-18 |
| Are there limits on the number of physical therapy visits allowed? | Variable | Case specific | Refer to case manager for guidance |
| Are there limits on payment per visit for outpatient therapy services? | Variable | Case specific | Refer to case manager for guidance |
| Do regulations require use of treatment guidelines? | No | KRS 342.020(8) says commissioner shall provide or adopt practice parameters | https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=50956 |
| Is a referral required in order to see a physical therapist? | Yes | KRS 342.020(5) | https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=50956 |
| Can outpatient fees be negotiated above or below the fee schedule? 1 | Variable |
Rehabilitation, or long-term acute care hospital shall be assigned a cost-to-charge ratio equal to 125 percent of the average adjusted cost-to-charge ratio of all in-state acute care hospitals; See definition 803 KAR 25:091 Section 5(1b)And, lower fees may be agreed to per 803 KAR 25:089(2b) and (2c) |
http://www.lrc.ky.gov/kar/803/025/091.htm http://www.lrc.ky.gov/kar/803/025/089.htm |
| Can the injured worker be charged for any claim-related services? | No | 803 KAR 25:096, Section 10 | https://apps.legislature.ky.gov/law/kar/titles/803/025/096/ |
| 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 | 803KAR25:110 | https://apps.legislature.ky.gov/law/kar/titles/803/025/096/ |
| Are there regulations that address which fee schedule applies if an injured worker from this state seeks treatment in another state? | Yes | 803 KAR25:089 Section 4 | https://apps.legislature.ky.gov/law/kar/titles/803/025/089/ |
| Are there regulations regarding Functional Capacity Evaluations (FCEs)? | No |
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