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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 Labor,
Division of Labor & Management, Workers' Compensation
Contact Information:
South Dakota WC Contact Form
News & Updates:
Subscribe to E-lerts
Other:
Rules and Fee Schedule
Therapy Regulations
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | $6.40 | Administrative Rule 47:03:05:05 | http://legis.state.sd.us/rules/DisplayRule.aspx?Rule=47:03:05:05 |
| What is the basis of the fee schedule for outpatient therapy services? | RVP | Administrative Rule 47:03:05:02 | http://legis.state.sd.us/rules/DisplayRule.aspx?Rule=47:03:05:02 |
| Are there limits on the number of physical therapy visits allowed? | No | ||
| Are there limits on payment per visit for outpatient therapy services? | No | ||
| Do regulations require use of treatment guidelines? | No | Previously existed – repealed December 2011 | |
| 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 - | Administrative Rule 47:03:05:05: A health care provider is not entitled to payment from an insurer or employee for fees in excess of the maximum reimbursement allowed. | http://legis.state.sd.us/rules/DisplayRule.aspx?Rule=47:03:05:05 |
| Can the injured worker be charged for any claim-related services? | Yes | No-show can be charged if patient informed and acknowledges (preferably in writing) that no-shows will be charged to him/her. | |
| 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 | SDCL 58-20-24; SDCL 62-5-21; ARSD 47:03:04 |
http://legis.state.sd.us/statutes/DisplayStatute.aspx?Statute=58&Type=Statute http://legis.state.sd.us/statutes/DisplayStatute.aspx?Statute=62&Type=Statute http://legis.state.sd.us/rules/DisplayRule.aspx?Rule=47:03 |
| Are there regulations that address which fee schedule applies if an injured worker from this state seeks treatment in another state? | Yes | Subject to the fee schedule of the state in which services are provided | |
| Are there regulations regarding Functional Capacity Evaluations (FCEs)? | Yes | ||
| Are there workers' compensation regulations about who can provide services under the direction and supervision of a physical therapist? | 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 - No
Exclusive State Fund - No
State Comp Fund (last resort) - No