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 › OCCUPATIONAL THERAPY › Section 296-23-230 - Occupational 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 for information
				  regarding the conversion factors.
All supplies and materials must be billed using HCPCS Level
				  II codes, refer to the department's billing instructions for additional
				  information.
Occupational therapy treatment will be reimbursed only when
				  ordered by the worker's attending doctor and rendered by a licensed
				  occupational therapist or an occupational therapist assistant serving under the
				  direction of a licensed occupational therapist. In addition, physician
				  assistants may order occupational therapy under these rules for the attending
				  doctor. Vocational counselors assigned to injured workers by the department or
				  self-insurer may request an occupational therapy evaluation. However,
				  occupational therapy treatment must be ordered by the worker's attending doctor
				  or by the physician assistant.
An occupational therapy progress report must be submitted to
				  the attending doctor and the department or self-insurer following 12 treatment
				  visits or one month, whichever occurs first. Occupational therapy treatment
				  beyond the 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.
The department or self-insurer will review the quality and
				  medical necessity of occupational therapy services. Practitioners should refer
				  to WAC 296-20-01002 for the department's definition of medically necessary and
				  to WAC 296-20-024 for the department's rules regarding utilization review and
				  quality assurance.
The department will pay for a maximum of one occupational
				  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 occupational therapy
				  which 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 occupational
				  therapists who render care to workers.
Occupational therapy services rendered in the worker's home
				  and/or places other than the practitioner's usual and customary office, clinic,
				  or business facility will be allowed only upon prior authorization by the
				  department or self-insurer.
No inpatient occupational 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).
Billing codes, reimbursement levels, and supporting policies
				  for occupational therapy services are listed in the fee
				  schedules.
Statutory Authority:
					 RCW
					  51.04.020(1) and
					 51.04.030. 12-11-107, §
					 296-23-230, filed 5/22/12, effective 7/1/12; 08-09-121, § 296-23-230,
					 filed 4/22/08, effective 7/1/08; 07-10-082, § 296-23-230, filed 5/1/07,
					 effective 7/1/07; 06-09-071, § 296-23-230, filed 4/18/06, effective
					 7/1/06. Statutory Authority:
					 RCW
					  51.04.020 and
					 51.04.030. 05-18-030, §
					 296-23-230, filed 8/30/05, effective 10/1/05. Statutory Authority:
					 RCW
					  51.04.020(1) and
					 51.04.030. 05-09-062, §
					 296-23-230, filed 4/19/05, effective 7/1/05; 04-09-100, § 296-23-230,
					 filed 4/20/04, effective 7/1/04; 03-14-043, § 296-23-230, filed 6/24/03,
					 effective 8/1/03; 02-10-129, § 296-23-230, filed 5/1/02, effective 7/1/02;
					 01-10-026, § 296-23-230, filed 4/24/01, effective 7/1/01; 00-09-077,
					 § 296-23-230, filed 4/18/00, effective 7/1/00. Statutory Authority:
					 RCW
					  51.04.020(4) and
					 51.04.030. 99-10-043, §
					 296-23-230, filed 4/30/99, effective 7/1/99; 98-09-125, § 296-23-230,
					 filed 4/22/98, effective 7/1/98; 97-10-017, § 296-23-230, filed 4/28/97,
					 effective 7/1/97; 96-10-086, § 296-23-230, filed 5/1/96, effective 7/1/96;
					 95-05-072, § 296-23-230, filed 2/15/95, effective 3/18/95. Statutory
					 Authority:
					 RCW
					  51.04.020,
					 51.04.030 and 1993 c 159.
					 94-02-045, § 296-23-230, filed 12/30/93, effective 3/1/94; 93-16-072,
					 § 296-23-230, filed 8/1/93, effective
					 9/1/93.