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 firstname.lastname@example.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.
Department of Employment Services, Office of Workers' Compensation
News & Updates:
See: Division V, Title 32 Labor, Chapter 15 Workers’ Compensation (section 1507 regarding Medical services, supplies and insurance)
See: 7-212 regarding Medical services and supplies
|What is the conversion factor for outpatient therapy services?||113% of Medicare||Percentage of Medicare Division V, Title 32, Chapter 15 (DC ST § 32-1507, (a-1)(5)||http://government.westlaw.com/linkedslice/default.asp?SP=DCC-1000|
|What is the basis of the fee schedule for outpatient therapy services?||RBRVS||113% of Medicare; DC ST § 32-1507(a-1)(5) Div V, Title 32, Ch 15, section 1507||http://government.westlaw.com/linkedslice/default.asp?SP=DCC-1000|
|Are there limits on the number of physical therapy visits allowed?||No||Per DC ST § 32-1507(6) May be subject to utilization review||http://government.westlaw.com/linkedslice/default.asp?SP=DCC-1000|
|Are there limits on payment per visit for outpatient therapy services?||No|
|Do regulations require use of treatment guidelines?||No|
|Is a referral required in order to see a physical therapist?||Unknown|
|Can outpatient fees be negotiated above or below the fee schedule? 1||No|
|Can the injured worker be charged for any claim-related services?||No||Rule 7-212 Medical Services and Supplies (8)||http://www.dcregs.dc.gov/Gateway/ChapterHome.aspx?ChapterNumber=7-2|
|Are there workers' compensation regulations about who can provide services under the direction and supervision of a physical therapist?||No|
|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?||No|
|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