Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › PHYSICAL THERAPY › Section 296-23-220 - Physical therapy rules

Current through Register Vol. 24-14, July 15, 2024
Practitioners should refer to WAC 296-20-010 through
				  296-20-125 for general information and rules pertaining to the care of
				  workers.
Refer to WAC 296-20-132 and 296-20-135 regarding the use of
				  conversion factors.
All supplies and materials must be billed using HCPCS Level
				  II codes. Refer to chapter 296-21 WAC for additional information. HCPCS codes
				  are listed in the fee schedules.
Refer to chapter 296-20 WAC (WAC 296-20-125) and to the
				  department's billing instructions for additional information.
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). In addition, physician assistants may
				  order physical therapy under these rules for the attending doctor. Doctors
				  rendering physical therapy should refer to WAC 296-21-290.
The department or self-insurer will review the quality and
				  medical necessity of physical therapy services provided to workers.
				  Practitioners should refer to WAC 296-20-01002 for the department's rules
				  regarding medical necessity and to WAC 296-20-024 for the department's rules
				  regarding utilization review and quality assurance.
The department or self-insurer will pay for a maximum of one
				  physical therapy visit per day. When multiple treatments (different billing
				  codes) are performed on one day, the department or self-insurer will pay either
				  the sum of the individual fee maximums, the provider's usual and customary
				  charge, or $147.97 whichever is less. These limits will not apply to physical
				  therapy that is rendered as part of a physical capacities evaluation, work
				  hardening program, or pain management program, provided a qualified
				  representative of the department or self-insurer has authorized the
				  service.
The department will publish specific billing instructions,
				  utilization review guidelines, and reporting requirements for physical
				  therapists who render care to workers.
Use of diapulse or similar machines on workers is not
				  authorized. See WAC 296-20-03002 for further information.
A physical therapy progress report must be submitted to the
				  attending doctor and the department or the self-insurer following 12 treatment
				  visits or one month, whichever occurs first. Physical therapy treatment beyond
				  initial 12 treatments will be authorized only upon substantiation of
				  improvement in the worker's condition. An outline of the proposed treatment
				  program, the expected restoration goals, and the expected length of treatment
				  will be required.
Physical therapy services rendered in the home and/or places
				  other than the practitioner's usual and customary office, clinic, or business
				  facilities will be allowed only upon prior authorization by the department or
				  self-insurer.
No inpatient physical therapy treatment will be allowed when
				  such treatment constitutes the only or major treatment received by the worker.
				  See WAC 296-20-030 for further information.
The department may discount maximum fees for treatment
				  performed on a group basis in cases where the treatment provided consists of a
				  nonindividualized course of therapy (e.g., pool therapy; group aerobics; and
				  back classes).
Biofeedback treatment may be rendered on doctor's orders
				  only. The extent of biofeedback treatment is limited to those procedures
				  allowed within the scope of practice of a licensed physical therapist. See
				  chapter 296-21 WAC for rules pertaining to conditions authorized and report
				  requirements.
Billing codes and reimbursement levels are listed in the fee
				  schedules.
Statutory Authority:
					 RCW
					  51.04.020(1) and
					 51.04.030. 12-11-107, §
					 296-23-220, filed 5/22/12, effective 7/1/12; 08-09-121, § 296-23-220,
					 filed 4/22/08, effective 7/1/08; 07-10-082, § 296-23-220, filed 5/1/07,
					 effective 7/1/07; 06-09-071, § 296-23-220, filed 4/18/06, effective
					 7/1/06. Statutory Authority:
					 RCW
					  51.04.020 and
					 51.04.030. 05-18-030, §
					 296-23-220, filed 8/30/05, effective 10/1/05. Statutory Authority:
					 RCW
					  51.04.020(1) and
					 51.04.030. 05-09-062, §
					 296-23-220, filed 4/19/05, effective 7/1/05; 04-09-100, § 296-23-220,
					 filed 4/20/04, effective 7/1/04; 03-14-043, § 296-23-220, filed 6/24/03,
					 effective 8/1/03; 02-10-129, § 296-23-220, filed 5/1/02, effective 7/1/02;
					 01-10-026, § 296-23-220, filed 4/24/01, effective 7/1/01; 00-09-077,
					 § 296-23-220, filed 4/18/00, effective 7/1/00. Statutory Authority:
					 RCW
					  51.04.020(4) and
					 51.04.030. 99-10-043, §
					 296-23-220, filed 4/30/99, effective 7/1/99; 98-09-125, § 296-23-220,
					 filed 4/22/98, effective 7/1/98; 97-10-017, § 296-23-220, filed 4/28/97,
					 effective 7/1/97; 96-10-086, § 296-23-220, filed 5/1/96, effective 7/1/96;
					 95-05-072, § 296-23-220, filed 2/15/95, effective 3/18/95. Statutory
					 Authority:
					 RCW
					  51.04.020,
					 51.04.030 and 1993 c 159.
					 94-02-045, § 296-23-220, filed 12/30/93, effective 3/1/94; 93-16-072,
					 § 296-23-220, filed 8/1/93, effective
					 9/1/93.