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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:
Workers'Compensation Commission
Contact Information:
E-mail Illinois WCC
News & Updates: Illinois WC News
Other:
Workers' Compensation Act
Fee Schedule
Frequently Asked Medical Questions
Handbook on Workers' Compensation and Occupational Diseases
Therapy Regulations
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | Not applicable | Fee schedule not tied to conversion factor | http://www.iwcc.il.gov/Section7110.90--020109.pdf |
| What is the basis of the fee schedule for outpatient therapy services? | Other | 90% of 80th %ile charges from 8/2002 to 7/2004 (by geozip), updated annually by CPI-U. 30% fee schedule decrease adopted in 2011 workers' compensation reforms | http://www.iwcc.il.gov/Section7110.90--020109.pdf |
| Are there limits on the number of physical therapy visits allowed? | No | "The employer is required to pay for all medical care that is reasonably necessary to cure or relieve the employee from the effects of the injury. This includes but is not limited to…physical therapy…" See chapter 5, Medical Benefits in Handbook on Workers' Compensation and Occupational Diseases | http://www.iwcc.il.gov/handbook062811.pdf |
| 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? | Regulation silent | Refer to state practice act | |
| Can outpatient fees be negotiated above or below the fee schedule? 1 | Yes + / - | Section 7110.90(d) of 50 Illinois Administrative Code states, in part: "if an employer or insurance carrier contracts with a provider for the purposes of providing services under the Act, the rate negotiated in the contract shall prevail." | http://www.iwcc.il.gov/Section7110.90--020109.pdf |
| Are there workers' compensation regulations about who can provide services under the direction and supervision of a physical therapist? | No | Balance billing is not allowed, see FAQ | http://www.iwcc.il.gov/faqmed.htm#bb |
| 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 | Anticipate development of provider networks following 2011 reform | |
| Are there regulations regarding Functional Capacity Evaluations (FCEs)? | Yes | Depends on where claim was filed, see FAQ | http://www.iwcc.il.gov/faqmed.htm#out |
| Are there workers' compensation regulations about who can provide services under the direction and supervision of a physical therapist? | 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