Section 418.10212. Physical and occupational therapy; physical medicine services; physical treatment.

(1) For the purposes of workers' compensation, physical medicine services, procedure codes 97010-97799, shall be referred to as   "physical treatment" when the services are provided by a practitioner other than a physical therapist or an occupational therapist. Physical therapy means physical treatment provided by a licensed physical therapist. Occupational therapy means physical treatment provided by an occupational therapist.

(2)   Physical medicine services shall be restorative. If documentation does not support the restorative nature of the treatment, then the service shall not be reimbursed.

(3)    Any of the following may provide physical treatment, to the extent that licensure, registration, or certification law allows:

(a)   A doctor of medicine.

(b)   A doctor of osteopathic medicine and surgery.

(c)   A doctor of dental surgery.

(d)  A doctor of chiropractic.

(e)   A doctor of podiatric medicine and surgery.

(f)  A physical therapist.

(g)   An occupational therapist.

(4)      Only a licensed physical therapist, licensed occupational therapist, or licensed practitioner may use procedure codes 97001-97004 to describe the physical medicine and rehabilitation evaluation services. Job-site evaluations may  be  paid  to  a  licensed occupational therapist, a licensed physical therapist, or a physician. Job-site evaluations for workers' compensation are by report and are described on the bill using codes WC500- WC600.

(5)   If a practitioner performs and bills for physical treatment, then the practitioner shall do all of the following:

(a)   Perform an initial evaluation.

(b)   Develop a treatment plan.

(c)   Modify the treatment as necessary.

(d)   Perform a discharge evaluation. The practitioner shall provide the carrier with an initial evaluation and a progress report every 30 calendar days and at discharge. Documentation requirements are the same as the requirements in R 418.10204(2).

(6)     A provider shall report procedure code 97750 to describe a functional capacity evaluation. The carrier shall reimburse a maximum of 24 units or 6 hours for the initial evaluation. Not more than 4 additional units shall  be billed for a re-evaluation occurring within 2 months.

(7)    Physical medicine modalities are those agents applied  to   produce therapeutic changes to tissue and include, but are not limited to, thermal, acoustic, light, mechanical, or electric energy. Both of the following apply:

(a)    Supervised modalities include procedure codes 97010-97028. These codes do not require direct 1-on-1 patient contact by the provider. These modalities shall be performed in conjunction with a therapeutic procedure including manipulative services or the modalities shall not be reimbursed.

(b)   Constant attendance modalities are those  procedure  codes   97032-97039 that require direct 1-on-1 patient contact by the provider.

(8)   Therapeutic procedure codes 97110-97546 are procedures that  effect change through the application of clinical skills and services that attempt to improve function. The physician or therapist shall have direct  1-on-1 patient contact.

(9)   The following provisions apply to the listed modality services:

(a)     Whirlpool   shall  only  be  reimbursed  when   done  for  debridement  or   as  part  of  a restorative physical treatment program.

(b)   Procedure 97010 is a bundled procedure code and shall not be reimbursed separately.

(c)   Not more than 1 deep heat procedure shall be billed on the same date of service for the same diagnosis. Deep heat procedures include diathermy, microwave, ultrasound, and phonophoresis.

(d)  Phonophoresis shall be billed using procedure code 97035 with modifier code -22 and shall be reimbursed at the same rate as procedure code 97035, plus $2.00 for the active ingredient used in the process.

(e)     Iontophoresis shall include the solution, medication,  and   the electrodes.

(f)  ) Electrical stimulation shall include the electrodes.

(g)    Procedure codes 97032, 97033, and 97035 shall not be   reimbursed   to   a doctor of chiropractic.

(h)   Fluidotherapy, a dry whirlpool treatment, shall be reported using code 97022.

History: 1998-2000 AACS; 2006 AACS; 2009 AACS; 2010 MR 23, Eff. Dec. 8,