By using this site, you are consenting to our use of cookies. To find out more visit our privacy policy.
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:
Louisiana Workforce Commission, Office of Workers' Compensation
Contact information:
See Office of Workers' Compensation
News & Updates:
None
Other:
Fee Schedule (see "CPT Codes – 2000 Update"). Note: transition to CPT 2013 is anticipated during 2013.
Therapy Regulations
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | Not applicable | Fee schedule not tied to a conversion factor | http://www.laworks.net/Downloads/Downloads_OWC.asp#Medical |
| What is the basis of the fee schedule for outpatient therapy services? | Other | BCBS Relative Value Scale (1994); relative values not updated since promulgation, per WCRI report | Workers' Compensation Medical Cost Containment: A National Inventory, 2011 (WCRI report WC-11-35, April 2011) |
| Are there limits on the number of physical therapy visits allowed? | Yes | Requires prior authorization, use Form 1010 Visit limits based on medical guidelines |
http://www.laworks.net/Downloads/OWC/1010form.pdf http://www.laworks.net/WorkersComp/OWC_MedicalGuidelines.asp |
| Are there limits on payment per visit for outpatient therapy services? | Yes | To the extent approved/authorized on Form 1010. | |
| Do regulations require use of treatment guidelines? | Yes | State-specific for spine, pain, neurological & neuromuscular, and upper and lower extremities | http://www.laworks.net/WorkersComp/OWC_MedicalGuidelines.asp |
| Is a referral required in order to see a physical therapist? | Yes | Prescription/referral and authorization required for payment | None provided |
| Can outpatient fees be negotiated above or below the fee schedule? 1 | Yes | WCRI report indicates can only be negotiated lower than 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 | Defaults to state practice act | |
| Are there provider network and/or managed care regulations in place? | No | Not regulated, but use is allowed | Workers' Compensation Medical Cost Containment: A National Inventory, 2011 (WCRI report WC-11-35, April 2011) |
| Are there regulations that address which fee schedule applies if an injured worker from this state seeks treatment in another state? | Unknown | ||
| Are there regulations regarding Functional Capacity Evaluations (FCEs)? | Yes | See Medical Guidelines:
Cervical Spine Injury - Chapter 20 Subchapter A §2007 (C)(3)(b)(i) & (ii) Low Back Pain - Chapter 20 Subchapter A §2019 (C)(3)(b)(i) & (ii) ______________________ Chronic Pain Disorder - Chapter 21 Subchapter A §2109 (A)(6)(b) CRPS - Chapter 21 Subchapter B §2127 (E)(4) _______________________ Chronic Pain Disorder - Chapter 21 Subchapter A §2109 (A)(6)(b) CRPS - Chapter 21 Subchapter B §2127 (E)(4) _________________________ Lower Extremities - Chapter 23 Subchapter A §2307 (C)(3)(b)(i) Shoulder Injuries - Chapter 23 Subchapter B §2321 (C)(4)(b) |
http://www.laworks.net/Download/OWC/MedicalGuidelines_Spine.pdf ______________________ http://www.laworks.net/Downloads/OWC/MedicalGuidelines_Pain.pdf _________________________ http://www.laworks.net/Downloads/OWC/MedicalGuidelines_NeurologicalNeuromuscularDisorder.pdf _________________________ http://www.laworks.net/Downloads/OWC/MedicalGuidelines_UpperLowerExtremities.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) - Yes