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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 (WCC)
Contact information:
Maryland WCC Contacts
E-mail WCC Support
News & Updates:
WCC Notices & Announcements
Other:
Medical Fee Guide Information
Guide of Medical and Surgical Fees for rules
Medical Services and Treatment – Reimbursement Rates for fee schedule
Therapy Regulations
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | $42.18 | Maryland Specific Conversion Factor for Medical Services & Treatment | www.wcc.state.md.us/PDF/MFG/MEI_2012.pdf |
| What is the basis of the fee schedule for outpatient therapy services? | RBRVS | Guide of Medical and Surgical Fees 14.09.03 Section .03(E), pp. 4-5 | www.wcc.state.md.us/PDF/MFG/COMAR_MFG_Reg_2008.pdf |
| Are there limits on the number of physical therapy visits allowed? | No | ||
| Are there limits on payment per visit for outpatient therapy services? | Yes | Only one modality per session per Guide of Medical and Surgical Fees 14.09.03 Section .05(I), p 7,br /> Section .05(H) states no MPPR for 97010-97799 | www.wcc.state.md.us/PDF/MFG/COMAR_MFG_Reg_2008.pdf |
| Do regulations require use of treatment guidelines? | No | ||
| Is a referral required in order to see a physical therapist? | No | PT recognized as treating provider, not subject to referral | Workers' Compensation Medical Cost Containment: A National Inventory, 2011 (WCRI report WC-11-35, April 2011) |
| Can outpatient fees be negotiated above or below the fee schedule? 1 | Yes + / - | Fees can be negotiated above or below the MRA (Maximum Reimbursement Allowable) per private agreement. Guide of Medical and Surgical Fees 14.09.03 Section .01(B)(12), p. 2 | www.wcc.state.md.us/PDF/MFG/COMAR_MFG_Reg_2008.pdf |
| Can the injured worker be charged for any claim-related services? | No | All related health care services are paid by the employer/insurer. | |
| 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 | Not regulated, but use is allowed | Workers' Compensation Medical Cost Containment: A National Inventory, 2011 (WCRI report WC-11-35, April 2011) |
| 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 - Yes
Exclusive State Fund - No
State Comp Fund (last resort) - No