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:
Labor Commission, Industrial Accidents Division
Contact Information:
E-mail Industrial Accidents Division
Phone: 801/530-6800
Toll Free: (UT) 800/530-5090
News & Updates:
Labor Commission newsletters
Other:
Medical fee guidelines and standards
Hover on "Search the Medical Fee Standards" in the right navigation field
Therapy Regulations
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | $46.00 | P. 3 2013 medical fee guidelines | Medical Fee Standards Hover on Medical Fee Standards, and select 2012 Guidelines |
| What is the basis of the fee schedule for outpatient therapy services? | RBRVS | Utah Admin Code R612-300-5.A.2. Regulation of Medical Practitioner Fees | www.rules.utah.gov/publicat/code/r612/r612-300.htm#T5 |
| Are there limits on the number of physical therapy visits allowed? | Yes | Must justify functional improvement at 8 visits. R612-2-3. Filings. Subsection B (p. 30) of 2013 Medical Fee Guidelines |
Medical Fee Standards Hover on Medical Fee Standards, and select 2012 Guidelines |
| Are there limits on payment per visit for outpatient therapy services? | Yes | 2013 Medical Fee Guidelines, p. 14, I. General Guidelines for Reimbursement, subsection 1 Limit 3 procedures/units per visit; 6 if treating different sites (may bill for additional, payer shall pay the three highest) PTA services to be billed and reimbursed at 75% using modifier 83 (pp. 9-10) |
Medical Fee Standards Hover on Medical Fee Standards, and select 2012 Guidelines |
| Do regulations require use of treatment guidelines? | No | Carriers may adopt if approved by the state | |
| Is a referral required in order to see a physical therapist? | Yes | Page 8, Medical Fee Guidelines 2012 (section D, Non-physician services) | Medical Fee Standards Hover on Medical Fee Standards, and select 2012 Guidelines |
| Can outpatient fees be negotiated above or below the fee schedule? 1 | Yes - | Page 4, Medical Fee Guidelines 2013 (section C2. Maximum allowable fee); if there is a contract for a discount, the discount applies | Medical Fee Standards Hover on Medical Fee Standards, and select 2012 Guidelines |
| 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 | Medical Fee Standards B.3.f requires that ROM be performed by a licensed therapist. Otherwise, state practice act would apply. | Medical Fee Standards Hover on Medical Fee Standards, and select 2012 Guidelines |
| Are there provider network and/or managed care regulations in place? | Yes | Utah Code Ann 34A-2-111 | http://le.utah.gov/code/TITLE34A/htm/34A02_011100.htm |
| Are there regulations that address which fee schedule applies if an injured worker from this state seeks treatment in another state? | Yes | Must apply Utah's fee schedule per Utah Labor Commission Medical Director | |
| Are there regulations regarding Functional Capacity Evaluations (FCEs)? | Yes | Title IV (B)(7), pp. 25-26 Medical Fee Guidelines | http://laborcommission.utah.gov/media/pdfs/industrialaccidents/pubs/2013%20MED%20FEE%20Modified%2011-29-2012.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 - Yes
Self-insured Employers or Groups - Yes
Competitive State Fund - Yes
Exclusive State Fund - No
State Comp Fund (last resort) - No