A.Therapeutic Services. Therapeutic services are an integral part of the healing process for a variety of injured workers. Recognizing this, the Fee Schedule includes codes for physical medicine, modalities, procedures, tests, and measurements in the Therapeutic Services section representing specific therapeutic procedures performed by licensed physicians, chiropractors, licensed physical therapists, licensed occupational therapists, and speech pathologists.B.Selection of Providers. Physical or occupational therapy, including work hardening, functional capacity evaluations, chronic pain programs, or massage therapy shall be provided upon referral from a physician. In the absence of specific direction from the treating or prescribing physician, the selection of a provider for these services shall be made by the payer in consultation with the treating or prescribing physician. No party, in attempting to negotiate a repricing or other post treatment price reduction agreement, shall state or imply that consent to such an agreement is mandatory, or that the failure to enter into any such agreement may result in audit, delay of payment, or other adverse consequence. If the MWCC determines that any party, or other person in privity therewith, has made such false or misleading statements in an effort to coerce another party's consent to a repricing or other price reduction agreement outside the Fee Schedule, the MWCC may refer the matter to the appropriate authorities to consider whether such conduct warrants criminal prosecution under § 71-3-69 of the Law.
C.Physical Medicine Assessment1. An assessment must be performed to determine if a patient will benefit from therapeutic services.2. When a physician examines a patient and an assessment for therapeutic services is performed, the billing for the office visit includes the therapeutic assessment.3. Procedure codes 97161-97163 are used for an initial assessment by physical therapists. Code 97164 is used for re-evaluation of a patient by physical therapists. Procedure codes 97165-97167 are used for an initial assessment by occupational therapists. Code 97168 is used for re-evaluation of a patient by occupational therapists. Procedure codes from 92521-92523 are used for an initial assessment by a speech-language pathologist.D.Plan of Care1. An initial plan of care must be developed and filed with the payer regardless of whether therapy is provided by a physician or eligible practicing therapist. The content of the plan of care, at a minimum, should contain: a. The specific therapies to be provided, including the frequency and duration of each;b. The estimated duration of the therapeutic regimen; andc. The potential degree of restoration; and measurable goals (e.g., potential restoration is good, poor, low, guarded).2. The initial plan of care must be signed by the treating physician and submitted to the payer within fourteen (14) days of approval. Physicians are required to sign the plan of care for physical and/or occupational therapy or speech-language pathology. The physician's signature indicates approval of the therapy the patient is receiving and for the length of time established for the therapy.3. The physician has the responsibility of providing documentation of medical necessity to the payer whenever there are questions regarding the extent of therapy being provided or the appropriateness of the therapy regimen.4. A plan of care must be updated at least every thirty (30) days and submitted to the payer.5. Preparation of a care plan for therapy services does not warrant a separate fee.E.Qualifications for Reimbursement1. The patient's condition must have the potential for restoration of function.2. The treatment must be prescribed by the authorized attending or treating physician.3. The treatment must be specific to the injury and have the potential to improve the patient's condition.4. The physician or therapist must be on-site during the provision of services.