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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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Therapy Regulations

  • What is the conversion factor for outpatient therapy services?
  • What is the basis of the fee schedule for outpatient therapy services?
    • Response: Other
    • Detail: 90% of 80th percentile charges from 8/2002 to 7/2004 (by geozip), updated annually by CPI-U. 30% fee schedule decrease adopted in 2011 workers' compensation reforms
    • Citation: http://www.iwcc.il.gov/Section7110.90--020109.pdf
  • Are there limits on the number of physical therapy visits allowed?
    • Response: No
    • Detail: "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
    • Citation: http://www.iwcc.il.gov/handbook062811.pdf
  • Are there limits on payment per visit for outpatient therapy services?
    • Response: The maximum allowable payment is 70% of the fee schedule amounts for services, which are based on "geozips" (three-digit zip code areas).
  • Do regulations require use of treatment guidelines?
    • Response: In Illinois workers' compensation, there is no strict, legally mandated set of physical therapy treatment guidelines, but insurers heavily rely on established medical guidelines through Utilization Review (UR) to approve care. Treatment must be reasonable and necessary to cure or relieve the injury. 
  • Is a referral required in order to see a physical therapist?
    • Response: While Illinois law (Direct Access) allows patients to see a physical therapist without a doctor's referral for general,, it is generally required for workers' compensation claims to ensure insurance coverage. Although you can legally start therapy without one, workers' compensation insurance often requires a prescription or referral from a physician for treatment and payment. 
    • Detail: Refer to state practice act
  • Can outpatient fees be negotiated above or below the fee schedule? 1
    • Response: Yes, outpatient fees can be negotiated in Illinois workers' compensation cases. While the Illinois Workers’ Compensation Commission sets maximum fee schedules for medical services, the Act specifically allows employers and insurers to contract directly with providers for different reimbursement rates.
    • Detail: 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."
    • Citation: http://www.iwcc.il.gov/Section7110.90--020109.pdf
  • Can the injured worker be charged for any claim-related services?
    • Response: In Illinois, an injured worker generally cannot be charged for any claim-related services or medical treatment that is reasonable and necessary for a work-related injury. The employer's workers' compensation insurance must cover all medical costs, including doctor visits, surgery, and devices, without co-payments or deductibles. 
  • Are there workers' compensation regulations about who can provide services under the direction and supervision of a physical therapist?
    • Response: Yes, Illinois has strict regulations for services provided under a physical therapist (PT) in workers' compensation cases. Only licensed Physical Therapist Assistants (PTAs) or, in specific, limited capacities, trained aides can perform tasks under the supervision of a licensed PT. PTAs must work under the supervision of a licensed PT. 
    • Detail: Balance billing is not allowed, see FAQ
    • Citation: http://www.iwcc.il.gov/faqmed.htm#bb
  • Are there provider network and/or managed care regulations in place?
    • Response: Yes, Illinois workers' compensation has specific regulations for physical therapist services, primarily governed by employer-established Preferred Provider Programs (PPPs) and a state-mandated medical fee schedule. If an employer uses an approved PPP, employees are generally limited to selecting from that network for physical therapy, while non-PPP cases follow the two-provider choice rule.
  • Are there regulations that address which fee schedule applies if an injured worker from this state seeks treatment in another state?
    • Response: Yes, there are specific Illinois workers' compensation regulations that dictate which fee schedule applies when a worker receives medical treatment outside of Illinois. According to the Illinois Workers' Compensation Act (820 ILCS 305/8.2) and related administrative codes, the reimbursement for out-of-state treatment is designed to limit costs to either the Illinois rate or the local rate.
  • Are there regulations regarding Functional Capacity Evaluations (FCEs)?
    • Response: FCE's are commonly used for WC cases in Illinois. There are no specific regulations, FCE's are generally authorized to determine permanent restrictions and refusing to attend a requested FCE can lead to loss of benefits

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: Yes
  • Competitive State Fund: No
  • Exclusive State Fund: Yes
  • State Comp Fund (last resort): No

The Workers' Compensation resources have been updated as of 2026.

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