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 and Links

Agency

• Executive Office of Labor and Workforce Development, Department of Industrial Accidents 

Contact Information

• Massachusetts WC contacts 

News and Updates

• Massachusetts Government Website (See News and Updates in right navigation)

Other

• Medical Providers Handling Injured Workers
• 114.3 CMR 40.00 - Regulation (including fees)
• https://www.mass.gov/info-details/injured-workers-guide-to-workers-compensation

Therapy Regulations

• What is the conversion factor for outpatient therapy services?
  • Response: Does not use conversion factor
  • Detail: Schedule of maximum fees provided, see 40.06(12) Restorative Services
  • Citation: https://www.mass.gov/doc/rates-for-services-under-mgl-c-152-workers-compensation-act-april-1-2009-0/download
• What is the basis of the fee schedule for outpatient therapy services?
  • Response: Flat rate set by MA, billed based on CPT codes
  • Detail: There may be differences between private practice and hospital outpatient services. See hyperlinks
  • Citation: https://www.mass.gov/regulations/1143-CMR-4000-rates-for-services-under-mgl-c152-workers-compensation-act
    https://www.mass.gov/regulations/1141-CMR-4100-rates-of-payment-for-services-provided-to-industrial-accident-patients-by-hospitals-0
• Are there limits on the number of physical therapy visits allowed?
  • Response: Yes
  • Detail: Subject to treatment guidelines
  • Citation: http://www.mass.gov/lwd/workers-compensation/hcsb/tg
• Are there limits on payment per visit for outpatient therapy services?
  • Response: Yes
  • Detail: Obtain pre-auth if more than two procedures and/or more than three modalities are needed per session. Number of units allowed per session is limited only by medical necessity. 114.3 CMR 40.05(13)(g/h)
  • Citation: https://www.mass.gov/doc/1143-cmr-40-rates-for-services-under-mgl-c152-workers-compensation-act/download
• Do regulations require use of treatment guidelines?
  • Response: Yes
  • Detail: State-specific for different conditions, including several surgeries.
  • Citation: http://www.mass.gov/lwd/workers-compensation/hcsb/tg
• Is a referral required in order to see a physical therapist?
  • Response: No
  • Detail: Per state practice act; but some payers may require referral
  • Citation: https://www.mass.gov/regulations/259-CMR-500-physical-therapists
• Can outpatient fees be negotiated above or below the fee schedule? ¹
  • Response: Yes + / -
  • Detail: The insurer, employer and health care service provider may agree upon a different payment rate for any service set forth in the fee schedule in 114.3 CMR 40.00. (from section 40.01(2))
  • Citation: https://www.mass.gov/doc/1143-cmr-40-rates-for-services-under-mgl-c152-workers-compensation-act/download
• Can the injured worker be charged for any claim-related services?
  • Response: No
  • Detail: No employee may be held liable for the payment for health care services determined compensable under M.G.L. c. 152, § 13. Per section 2 of 114.3 CMR 40.01
  • Citation: https://www.mass.gov/doc/1143-cmr-40-rates-for-services-under-mgl-c152-workers-compensation-act/download
• Are there workers' compensation regulations about who can provide services under the direction and supervision of a physical therapist?
  • Response: No
• Are there provider network and/or managed care regulations in place?
  • Response: No
• Are there regulations that address which fee schedule applies if an injured worker from this state seeks treatment in another state?
  • Response: Yes
  • Detail: Pay at Massachusetts rate: 114.3 CMR 40.04(2)
  • Citation: https://www.mass.gov/doc/1143-cmr-40-rates-for-services-under-mgl-c152-workers-compensation-act/download
• Are there regulations regarding Functional Capacity Evaluations (FCEs)?
  • Response: Yes, indirectly. FCE's are considered evaluation services and thus fall under the same regulation as rehabilitative and evaluative services (like the services mentioned above)
  • Detail: Reimbursable only when: ordered by a treating physician or authorized provider; related to the compensable condition; medically appropriate and necessary; within the scope of practice of whoever is providing the evaluation
  • Citation: https://www.mass.gov/doc/1143-cmr-40-rates-for-services-under-mgl-c152-workers-compensation-act/download

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

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