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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 basis of the fee schedule for outpatient therapy services?
  • Are there limits on the number of physical therapy visits allowed?
  • Are there limits on payment per visit for outpatient therapy services?
  • Do regulations require use of treatment guidelines?
    • Response: The treatment guidelines adopted by BWC are the Official Disability Guidelines
    • Detail: The following rules indicate treatment guidelines may be used. OAC 4123-6-16.1, OAC 4123-6-25. The provider billing and reimbursement manual, Chapter 1 outlines that BWC uses ODG guidelines.
    • Citation: Use of Treatment Guidelines final TF 031224.pdf
  • Is a referral required in order to see a physical therapist?
  • Can outpatient fees be negotiated above or below the fee schedule? 1
  • Can the injured worker be charged for any claim-related services?
    • Response: No
    • Detail: An IW cannot be balanced billed or charged a co-pay for authorized services.
    • Citation: https://info.bwc.ohio.gov/
  • Are there workers' compensation regulations about who can provide services under the direction and supervision of a physical therapist?
    • Response: Yes
    • Detail: BWC would rely on the physical therapist’s license and scope of practice as well as the license/certification/scope of practice for the individual being supervised by the PT, however, BWC requires direct supervision of any provider who cannot be directly enrolled with BWC. As an example, a PT-A providing care to BWC IWs must be directly supervised. Direct supervision means that the supervisor is present with the PT-A at all times, as opposed to being available in the suite, etc., which is general supervision. Add the following to citation as CHAPTER 2 (ohio.gov) of the Provider Billing and Reimbursement Manual pages 2-6 under non-covered providers.
    • Citation: https://www.bwc.ohio.gov/downloads/blankpdf/BRMChapter2.pdf
  • Are there provider network and/or managed care regulations in place?
  • Are there regulations that address which fee schedule applies if an injured worker from this state seeks treatment in another state?
    • Response: Yes
    • Detail: OAC 4123-6-10 Rule 4123-6-10 - Ohio Administrative Code. An IW may not be able to seek treatment from another state if the provider is not-BWC certified and the treatment is otherwise available within a reasonable distance from the IW by a BWC-certified provider. If the fee schedule for care is higher in another states, BWC considers this a request for a negotiated rate, which would be discussed with the MCO. OAC 4123-6-10 should be reviewed which describes the situations when a payment can be negotiated
    • Citation: https://www.bwc.ohio.gov/downloads/blankpdf/BRMChapter1.pdf
  • Are there regulations regarding Functional Capacity Evaluations (FCEs)?

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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