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

• Departmentof Labor & Industries

Contact Information

• Provider Hotline: 800-848-0811
• Switchboard: 360-902-5800

News and Updates

• News Release Emails

Other

• Medical Providers 
• PT, OT and Massage
• Fee Schedules 

Therapy Regulations

• What is the conversion factor for outpatient therapy services?
  • Response: $58.33
• What is the basis of the fee schedule for outpatient therapy services?
  • Response: RBRVS
  • Detail: Payment Policies Introduction
  • Citation: https://lni.wa.gov/patient-care/billing-payments/fee-schedules-and-payment-policies/
• Are there limits on the number of physical therapy visits allowed?
  • Response: Yes
  • Detail: 12 without prior auth; 13-24 require auth; over 24 require UR
  • Citation: https://lni.wa.gov/patient-care/treating-patients/helping-workers-get-back-to-work/physical-occupational-massage-therapy
• Are there limits on payment per visit for outpatient therapy services?
  • Response: Yes
  • Detail:  The department or self-insurer will pay either the sum of the individual fee maximums, the provider's usual and customary charge, or $149.45 whichever is less. 
  • Citation: http://apps.leg.wa.gov/WAC/default.aspx?cite=296-23-220
• Do regulations require use of treatment guidelines?
  • Response: Yes
  • Detail: Multiple state-specific protocols
  • Citation: https://lni.wa.gov/patient-care/treating-patients/treatment-guidelines-and-resources/#treatment-guidelines-and-resources
• Is a referral required in order to see a physical therapist?
  • Response: Yes
  • Detail: "Physical therapy treatment will be reimbursed only when ordered by the worker's attending doctor and rendered by a licensed physical therapist, a physical therapist assistant serving under the direction of a licensed physical therapist as required in RCW 18.74.180 (3)(a), or a licensed athletic trainer serving under the direction of a licensed physical therapist as required in RCW 18.250.010 (4)(a)(v)."
• Can outpatient fees be negotiated above or below the fee schedule? ¹
  • Response: No
• Can the injured worker be charged for any claim-related services?
  • Response: Yes
  • Detail: Can charge for no-shows per WAC 296-20-010 General Information (6); must have policy applicable to all patients, communicate that policy, and L&I not responsible to enforce; effective 3/23/12
  • Citation: http://apps.leg.wa.gov/WAC/default.aspx?cite=296-20-010
• Are there workers' compensation regulations about who can provide services under the direction and supervision of a physical therapist?
  • Response: Yes
  • Detail: PTs, PTAs, ATCs
  • Citation: https://lni.wa.gov/patient-care/treating-patients/helping-workers-get-back-to-work/physical-occupational-massage-therapy
• Are there provider network and/or managed care regulations in place?
  • Response: Yes
  • Detail: WA state requires participation in LNI or self-insured
  • Citation: https://lni.wa.gov/patient-care/provider-accounts/become-a-provider/
• Are there regulations that address which fee schedule applies if an injured worker from this state seeks treatment in another state?
  • Response: Yes
  • Detail: For hospital payments: paid using a percent of allowed charges (POAC) factor or department fee schedule.
• Are there regulations regarding Functional Capacity Evaluations (FCEs)?
  • Response: Yes
  • Detail: Chapter 24: Physical Medicine Services Payment Policy: Physical Capacities Evaluation
  • Citation: https://lni.wa.gov/patient-care/treating-patients/helping-workers-get-back-to-work/physical-occupational-massage-therapy#functional-capacity-evaluations

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.