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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 Workers' Compensation
Contact Information:
Kansas WC contacts
In particular, Medical Services & Fee Schedule
News & Updates:
Other:
Medical Services & Fee Schedule Section Schedule of Medical Fees
Guidelines
Therapy Regulations
Question | Response | Detail | Citation |
What is the conversion factor for outpatient therapy services? | $43.87 | Page 87, schedule of medical fees | http://www.dol.ks.gov/WC/doc/med_fees_2012.pdf |
What is the basis of the fee schedule for outpatient therapy services? | RBRVS | Page (i), schedule of medical fees | http://www.dol.ks.gov/WC/doc/med_fees_2012.pdf |
Are there limits on the number of physical therapy visits allowed? | Yes | Page 85 number 7 MAXIMUM NUMBER OF VISITS: Treatment beyond 21 visits must be authorized by the employer, the insurance carrier, the WCF or the KS DWC, unless prior authorization received for more |
http://www.dol.ks.gov/WC/doc/med_fees_2012.pdf |
Are there limits on payment per visit for outpatient therapy services? | No | ||
Do regulations require use of treatment guidelines? | No | * ODG adopted as standard of reference, but not mandated or required | http://www.dol.ks.gov/WC/odg.asp |
Is a referral required in order to see a physical therapist? | Yes | WRITTEN REFERRAL: A written referral by a health care provider, as defined by K.S.A. 44-508, is required for services to be provided by a physical or occupational therapist, exercise physiologist, or their assistants. Page 85, schedule of medical fees | http://www.dol.ks.gov/WC/doc/med_fees_2012.pdf |
Can outpatient fees be negotiated above or below the fee schedule? 1 | Yes - | Section 21 of physical medicine ground rules in the schedule of medical fees indicates that payment agreements for amounts less than the maximum fees will supersede the fee schedule | http://www.dol.ks.gov/WC/doc/med_fees_2012.pdf |
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? | Yes – | Ground rules section 1, AUTHORIZED PROVIDERS (PTA, Ex Phys) | http://www.dol.ks.gov/WC/doc/med_fees_2012.pdf |
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 | Introduction to Schedule of Medical Fees, page 2 | http://www.dol.ks.gov/WC/doc/med_fees_2012.pdf |
Are there regulations regarding Functional Capacity Evaluations (FCEs)? | 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