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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
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Health Care Services
Rules, Manuals & Fees
Therapy Regulations
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | $50.70 | For 2010. R 418.101002a Conversion factor for practitioner services | http://www.michigan.gov/documents/wca/10_Physical_Med_333620_7.pdf |
| What is the basis of the fee schedule for outpatient therapy services? | RBRVS | R 418.10106(3) | http://www.michigan.gov/documents/wca/wca_hcs_rules_2010_379499_7.pdf |
| Are there limits on the number of physical therapy visits allowed? | No | Health Care Services Rules, R418.10212 | http://www.michigan.gov/documents/wca/wca_hcs_rules_2010_379499_7.pdf |
| Are there limits on payment per visit for outpatient therapy services? | Yes | See R 418.10212 for all details: Procedure must accompany supervised modality; 1 deep heat per session per diagnosis: Also see R 418.10905 Billing for occupational and physical therapy and Chapter 12 Health Care Services Manual | http://www.michigan.gov/documents/wca/wca_hcs_rules_2010_379499_7.pdf http://www.michigan.gov/documents/wca/10_Manual_340330_7.pdf |
| Do regulations require use of treatment guidelines? | No | ||
| Is a referral required in order to see a physical therapist? | Yes | Chapter 12 Health Care Services manual says all PT/OT bills must have prescription referral attached (p. 56) | http://www.michigan.gov/documents/wca/10_Manual_340330_7.pdf |
| Can outpatient fees be negotiated above or below the fee schedule? 1 | Yes - | R 418.10101 (4); If a carrier and a provider have a contractual agreement designed to reduce the cost of workers' compensation health care services below what would be the aggregate amount if the fee schedule were applicable, the contractual agreement shall be exempt from the fee schedule. | http://www.michigan.gov/documents/wca/wca_hcs_rules_2010_379499_7.pdf |
| Can the injured worker be charged for any claim-related services? | No | R 418.10105 Rule 105, p 2 | http://www.michigan.gov/documents/wca/wca_hcs_rules_2010_379499_7.pdf |
| 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? | No | Not mandated | 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? | Yes | Based on site of service for provider | http://www.michigan.gov/documents/wca/wca_hcs_rules_2010_379499_7.pdf |
| Are there regulations regarding Functional Capacity Evaluations (FCEs)? | Yes | R418.10212 Rule 212(6) | http://www.michigan.gov/documents/wca/wca_hcs_rules_2010_379499_7.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