WAC 296-21-290
Physical medicine. (1) Whom does the
department authorize and pay for physical medicine or physical
therapy services? The department or self-insurer may authorize
and pay for physical medicine services from the following
providers:
• A medical or osteopathic physician who is "board
certified or board qualified" in the field of physical medicine
and rehabilitation; or
• A licensed physical therapist; or
• The injured worker's attending doctor, within the
limitations listed below.
The physical medicine services must be personally performed
by the:
• Physical medicine and rehabilitation physician; or
• Attending doctor; or
• Licensed physical therapist; or
• Physical therapist assistant employed by and serving
under the direction of a registered physical therapist, physical
medicine and rehabilitation physician, or attending doctor.
Note:
Licensed physical therapy provider rules are contained in chapter 296-23 WAC.
(2) When may the department or self-insurer pay the
attending doctor for physical medicine services? The department
or self-insurer may pay the attending doctor to provide physical
medicine modalities and/or procedures in the following
situations:
(a) The attending doctor's scope of practice includes
physical medicine modalities and procedures.
(b) Only the physical medicine modalities and procedures
allowed under the department's fee schedules and payment policies
will be authorized or paid.
(c) No more than six physical medicine visits may be
authorized and paid to the attending doctor. If the worker
requires treatment beyond six visits, the worker must be referred
to a licensed physical therapist or a board certified or
qualified physical medicine and rehabilitation physician for such
treatment. Payments will be made in accordance with the
department's fee schedules and payment policies.
(d) In remote areas, where no physical medicine and
rehabilitation specialist, licensed physical therapist or
physical therapist assistant is available, physical medicine
visits required by the patient's accepted condition(s) may be
authorized and paid to the attending doctor. Payments will be
made in accordance with the department's fee schedules and
payment policies.
(e) The attending doctor may bill for office visits in
addition to the physical medicine services only when a separately
identifiable office visit service is provided in addition to the
physical medicine service.
(3) What codes and fees are payable for physical medicine
services?
• The codes, reimbursement levels, and other policies for
physical medicine services are listed in the department's Medical
Aid Rules and Fee Schedules. Physicians licensed in physical
medicine and licensed physical therapists use CPT and/or HCPCS
codes, rules and payment policies as listed in the department's
Medical Aid Rules and Fee Schedules or provider bulletins.
• Attending doctors must use the local codes, rules and
payment policies published in the department's Medical Aid Rules
and Fee Schedules or provider bulletins.