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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 Business and Industry: Division of Industrial Relations, Workers' Compensation Section
Contact Information:
E-mail Workers' Compensation Section
News & Updates:
Select "Newsletters" from Workers' Compensation Section home page
WC Section e-mail enrollment request
Other:
Medical Information (includes Medical Fee Schedules)
Medical Provider Guide
Therapy Regulations
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | $9.77 | Nevada Medical Fee Schedule, page 1 - see fee schedule for various CF for other relevant services | http://dir.nv.gov/uploadedFiles/dirnvgov/content/WCS/MedicalDocs/2018 Medical Fee Schedule.pdf |
| What is the basis of the fee schedule for outpatient therapy services? | RVP | Nevada Medical Fee Schedule, page 1 | http://dirweb.state.nv.us/WCS/medical.htm |
| Are there limits on the number of physical therapy visits allowed? | Yes | Initial 6 visits do not require authorization; per page 2, paragraph 3 of Nevada Medical Fee Schedule | http://dirweb.state.nv.us/WCS/medical.htm |
| Are there limits on payment per visit for outpatient therapy services? | Yes | PTA services paid at 50% differential (use modifier -29) 16 RVP unit maximum value per day for Physical Medicine codes (except WH/WC), with exceptions. Per page 2, paragraphs 2 & 3 of Nevada Medical Fee Schedule |
http://dirweb.state.nv.us/WCS/medical.htm |
| Do regulations require use of treatment guidelines? | Yes | ACOEM; Per Nevada Administrative Code | www.leg.state.nv.us/NAC/NAC-616C.html#NAC616CSec123 |
| Is a referral required in order to see a physical therapist? | Yes | Injured employee must use Physician gatekeeper on list: "Will I be allowed to go to any doctor, chiropractor or therapist that I choose?" | http://dirweb.state.nv.us/WCS/FAQs.pdf |
| Can outpatient fees be negotiated above or below the fee schedule? 1 | Yes - | WCRI report indicates can only be negotiated 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 | Cannot charge for treatment related to the industrial injury or occupational disease. May charge for services not related to the employee’s industrial injury or occupational disease. See NRS 616C.135 | www.leg.state.nv.us/NRS/NRS-616C.html |
| Are there workers' compensation regulations about who can provide services under the direction and supervision of a physical therapist? | Yes | Services provided by a licensed physical therapist assistant must be identified with the modifier “-29” and will be reimbursed at 50 percent of the maximum allowable fee for licensed physical therapists. Per page 2 of Nevada Medical Fee Schedule. | http://dirweb.state.nv.us/WCS/medical.htm |
| Are there provider network and/or managed care regulations in place? | Yes | NRS 616A.280, NAC 616C.030 | www.leg.state.nv.us/NRS/NRS-616A.html#NRS616ASec280 www.leg.state.nv.us/NAC/NAC-616C.html#NAC616CSec030 |
| 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 | Report using Nevada specific code NV99060, see Nevada Medical Fee Schedule | http://dirweb.state.nv.us/WCS/medical.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