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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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Fee Schedule
Therapy Regulations
| Question | Response | Detail | Citation |
| What is the conversion factor for outpatient therapy services? | Not applicable | Fee schedule provided, see Hospital & medical fee schedules, then on the right, select X0000-X9999 for the RI WC Specific rates | www.risingms.com/RIFee/Pages/default.aspx |
| What is the basis of the fee schedule for outpatient therapy services? | Other | State-specific local codes (X7001-x7005); see Hospital & medical fee schedules, then select physical and occupational therapy for the codes, and on the right, select X0000-X9999 for the RI WC Specific rates | www.risingms.com/RIFee/Pages/default.aspx |
| Are there limits on the number of physical therapy visits allowed? | Yes | Approval required after 9 visits (General Therapy Guidelines, number 4) | www.courts.ri.gov/Courts/workerscompensationcourt/MedicalAdvisoryBoard/Pages/Protocols.aspx |
| Are there limits on payment per visit for outpatient therapy services? | Unknown | ||
| Do regulations require use of treatment guidelines? | Yes | Multiple state-specific protocols Therapy protocols also located in the Outpatient Physical and Occupational Therapy Protocol Guidelines |
www.courts.ri.gov/Courts/workerscompensationcourt/MedicalAdvisoryBoard/Pages/Protocols.aspx |
| Is a referral required in order to see a physical therapist? | Yes | Must be referred by treating physician | 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 - | Per WCRI, can only be negotiated lower than published rates, but no citation noted | Workers' compensation medical cost containment: A national inventory, 2011 (WCRI report WC-11-35, April 2011) |
| Can the injured worker be charged for any claim-related services? | No | ||
| Are there workers' compensation regulations about who can provide services under the direction and supervision of a physical therapist? | Yes | Therapy treatments may be provided by licensed therapy assistants as directed by the licensed physical therapist or by therapy aides under supervision of the licensed physical therapist – see Outpatient Physical and Occupational Therapy Protocols Guidelines. | www.courts.ri.gov/Courts/workerscompensationcourt/MedicalAdvisoryBoard/Pages/Protocols.aspx |
| Are there provider network and/or managed care regulations in place? | Yes | § 28-33-8.1 Managed care programs | www.rilin.state.ri.us/statutes/title28/28-33/28-33-8.1.HTM |
| 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)? | Yes | For fees, see: Medical & Hospital Fee Schedules (select Work hardening and functional capacity exam guidelines in the left column of the current fee schedule page) | www.risingms.com/RIFee/Pages/default.aspx |
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