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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 Workforce Development, Workers' Compensation Division (WCD)
Contact Information:
WI WCD contacts
News & Updates:
See WCD home page - Newsroom
ICD-10
Wisconsin's ICD-10 Partnership
Workers' Compensation and Third Party Liability Carriers in the State
Other:
Medical Providers
Treatment Guidelines (.pdf)
No fee schedule
Therapy Regulations
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | Not applicable | No fee schedule | |
| What is the basis of the fee schedule for outpatient therapy services? | Not applicable | No fee schedule | |
| Are there limits on the number of physical therapy visits allowed? | No |
Workers’ Compensation Medical Cost Containment: A National Inventory, 2021. Karen Rothkin. March 2021. WC-21-18. (https://www.wcrinet.org/reports/workers-compensation-medical-cost-containment-a-national-inventory-2021) |
|
| Are there limits on payment per visit for outpatient therapy services? | No | ||
| Do regulations require use of treatment guidelines? | Yes Intended only for treatment dispute resolution | DWD 81.01 through 81.14 WC treatment guidelines | https://dwd.wisconsin.gov/wc/medical/treatment-guidelines.htm |
| Is a referral required in order to see a physical therapist? | No | Physical therapy recognized as treating provider, not subject to referral |
Workers’ Compensation Medical Cost Containment: A National Inventory, 2021. Karen Rothkin. March 2021. WC-21-18. (https://www.wcrinet.org/reports/workers-compensation-medical-cost-containment-a-national-inventory-2021) |
| Can outpatient fees be negotiated above or below the fee schedule? 1 | No | There is no fee schedule; there is information about fee disputes | https://dwd.wisconsin.gov/wc/health-cost-dispute/reasonableness-fees.htm |
| 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 | ||
| Are there regulations that address which fee schedule applies if an injured worker from this state seeks treatment in another state? | Yes | The employee may treat with a medical practitioner not licensed in WI with the consent of the insurer. Consent is not necessary if the out-of-state treatment is based on a referral from a practitioner licensed in WI. | https://dwd.wisconsin.gov/wc/medical/med-treatment-selection.htm |
| Are there regulations regarding Functional Capacity Evaluations (FCEs)? | Yes | LBP - DWD 81.06 (1)(k) Neck Pain - DWD 81.07 (1)(k) Thoracic Back Pain - DWD 81.08 (1)(k) Upper Extremity Disorders - DWD 81.09 (1)(k) |
https://dwd.wisconsin.gov/wc/medical/treatment-guidelines.htm https://docs.legis.wisconsin.gov/code/admin_code/dwd/080_081/81 |
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