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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.

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Workforce Safety & Insurance (WSI)

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North Dakota WSI Contacts 

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Other:  
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Therapy Regulations

Question  Response  Detail  Citation 
What is the conversion factor for outpatient therapy services? Yes Limit two modalities per visit (WC Rules of Procedure 92-01-02-45.1 subs. 14) Note: modality not defined http://www.legis.nd.gov/information/acdata/pdf/92-01-02.pdf 
What is the basis of the fee schedule for outpatient therapy services? RBRVS    
Are there limits on the number of physical therapy visits allowed? Yes 10 treatments or thirty days without authorization (WC Rules of Procedure 92-01-02-34 subs. 5.d.) http://www.legis.nd.gov/information/acdata/pdf/92-01-02.pdf 
Are there limits on payment per visit for outpatient therapy services? Yes Limit two modalities per visit (WC Rules of Procedure 92-01-02-45.1 subs. 14) Note: modality not defined http://www.legis.nd.gov/information/acdata/pdf/92-01-02.pdf 
Do regulations require use of treatment guidelines? Yes Official Disability Guidelines

92-01-02-33(5). Utilization review and quality assurance
http://www.legis.nd.gov/information/acdata/pdf/92-01-02.pdf 
Is a referral required in order to see a physical therapist? Yes Must be referred by treating physician 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  No Reimbursement must be at published rate 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? Yes See ND Administrative Code 92-01-02-45.1 (8) - requires ABN http://www.legis.nd.gov/information/acdata/pdf/92-01-02.pdf 
Are there workers' compensation regulations about who can provide services under the direction and supervision of a physical therapist? Yes ND Century Code 65-05-07(1) The health care provider or doctor must be acting within the scope of the provider's or doctor's license or fees will be denied

See also 92-01-02-31(2). Who may be reimbursed
http://www.legis.nd.gov/cencode/t65c05.pdf

http://www.legis.nd.gov/information/acdata/pdf/92-01-02.pdf 
Are there provider network and/or managed care regulations in place? Yes NDCC 65-02-20 http://www.legis.nd.gov/cencode/t65c02.pdf 
Are there regulations that address which fee schedule applies if an injured worker from this state seeks treatment in another state? Yes Injured workers covered under North Dakota workers' compensation - ND fee schedule applies.  
Are there regulations regarding Functional Capacity Evaluations (FCEs)? Yes Prior approval required

Report required

WSI Specific Code: W0540
http://www.workforcesafety.com/library/documents/newsletters/PB09-03.pdf 

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 - No
Competitive State Fund - No
Exclusive State Fund - Yes
State Comp Fund (last resort) - No