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:
Departmentof Labor & Industries
Contact Information:
Provider Hotline 800/848-0811
Interactive Voice Response 800/831-5227
News & Updates:
News Release Emails
Other:
Medical Providers
PT, OT and Massage
Fee Schedules
Therapy Regulations
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | $55.34 | Published in WAC 296-20-135 | http://apps.leg.wa.gov/WAC/default.aspx?cite=296-20-135 |
| What is the basis of the fee schedule for outpatient therapy services? | RBRVS | Payment Policies Introduction | https://lni.wa.gov/patient-care/billing-payments/fee-schedules-and-payment-policies/ |
| Are there limits on the number of physical therapy visits allowed? | Yes | 12 without prior auth; 13-24 require auth; over 24 require UR | https://lni.wa.gov/patient-care/treating-patients/helping-workers-get-back-to-work/physical-occupational-massage-therapy |
| Are there limits on payment per visit for outpatient therapy services? | Yes | Daily maximum published in WAC 296-20-220 $119.01 | http://apps.leg.wa.gov/WAC/default.aspx?cite=296-23-220 |
| Do regulations require use of treatment guidelines? | Yes | Multiple state-specific protocols | http://www.lni.wa.gov/ClaimsIns/Providers/TreatingPatients/TreatGuide/default.asp |
| Is a referral required in order to see a physical therapist? | Yes | Must be ordered by attending doctor | http://apps.leg.wa.gov/WAC/default.aspx?cite=296-23-220 |
| Can outpatient fees be negotiated above or below the fee schedule? 1 | Yes | RCW 51.04.030(2) says dept to establish maximum fees; WAC 296-20-010(2) also affirms this | http://apps.leg.wa.gov/rcw/default.aspx?cite=51.04.030 http://apps.leg.wa.gov/wac/default.aspx?cite=296-20-010 |
| Can the injured worker be charged for any claim-related services? | Yes | Can charge for no-shows per WAC 296-20-010 General Information (6); must have policy applicable to all patients, communicate that policy, and L&I not responsible to enforce; effective 3/23/12 | http://apps.leg.wa.gov/WAC/default.aspx?cite=296-20-010 |
| Are there workers' compensation regulations about who can provide services under the direction and supervision of a physical therapist? | Yes | PTA only per WAC 296-23-220 Physical therapy rules. PTAs supervised by PTs maximum 2:1 ratio per state practice act | http://apps.leg.wa.gov/WAC/default.aspx?cite=296-23-220> WA State Physical Therapy Practice Act |
| Are there provider network and/or managed care regulations in place? | No | ||
| Are there regulations that address which fee schedule applies if an injured worker from this state seeks treatment in another state? | Yes | For hospital payments; other providers are paid at WA fee schedule rates | http://apps.leg.wa.gov/WAC/default.aspx?cite=296-23A-0230 |
| Are there regulations regarding Functional Capacity Evaluations (FCEs)? | Yes | Chapter 24: Physical Medicine Services Payment Policy: Physical Capacities Evaluation | https://lni.wa.gov/patient-care/treating-patients/helping-workers-get-back-to-work/physical-occupational-massage-therapy#functional-capacity-evaluations |
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 - No
Self-insured Employers or Groups - Yes
Competitive State Fund - No
Exclusive State Fund - Yes
State Comp Fund (last resort) - No