• Who can treat?
• Documenting
• Billing & Payment
• Treatment issues
• Resources

Contact Us

Who can treat?

The information below covers who may treat, the procedures and the authorization requirements for outpatient therapy services.

Who may perform physical, occupational, or massage therapy?

Who may perform physical, occupational, or massage therapy?

Therapist type:	Physical Therapy (PT)	Occupational Therapy (OT)	Massage Therapy (MT)
Must be:	Licensed Physical Therapist	Licensed Occupational Therapist	Licensed Massage Practitioner (LMP).
Or:	PT assistant under the direction of a licensed PT	OT assistant under the direction of a licensed OT	N/A.

Who else may perform these services?

• Medical or Osteopathic physicians who are board qualified or board certified in medicine and rehabilitation.
• Attending physicians who are not board qualified or board certified in physical medicine and rehabilitation. Special payment policies apply. See the Physical Medicine chapter in the Payment Policies (2,640 KB PDF / 15 min).

Can I get paid for services performed by other personnel?

No. L&I will not pay providers for services provided by:

• Exercise physiologists,
• Kinesiologists,
• Athletic trainers,
• Students,
• Aides, and
• Other unlicensed personnel.

Do I need to obtain authorization for the first 12 (PT/OT) or 6 (MT) visits?

No, but the services need to be ordered by the injured worker's attending doctor or their physician assistant or nurse practitioner.

What needs to be done to treat beyond the first 12 (PT/OT) or 6 (MT) visits?

You need to:

1. Document improvement in the worker's condition,
2. Document continued referral from the attending physician, and
3. Obtain authorization.

Note: Further treatment may be denied by the claim manager if documentation is not available or authorization is not obtained.

How do I obtain authorization for additional (outpatient) visits?

For State Fund claims: Effective July 1, 2007

Standard outpatient and work conditioning services - Action required

Standard outpatient and work conditioning services - Action required
# of visits	PT only or OT only	PT/OT combined
Visits 1 - 12	No authorization needed.	If less than 12 visits for both disciplines, no authorization needed.
Visits 13 - 24	Fax OT/PT Treatment Authorization Fax Request (F248‑055‑000) form for authorization.	If visits are between 13 - 24 for either discipline, fax OT/PT Treatment Authorization Fax Request (F248‑055‑000) form for authorization.
Visits beyond 24	Request Utilization Review from Qualis directly. Claim manager will authorize or deny.	If greater than 24 visits for either discipline, request Utilization Review from Qualis directly. Claim manager will authorize or deny.
Visit counts are the total number of visits per claim. New referrals, restart of therapy following surgery, or treatment of new conditions on the same claim do not start again at visit 1. Physical and occupational therapy visits accumulate separately. If Work Conditioning is provided by both PT and OT and greater than 24 visits have previously occurred for either therapy discipline, utilization review is required. If Work Conditioning is denied, L&I will allow up to 12 visits for the discipline that hasn't reached 12 visits.
Work hardening	Action required
All services	Request authorization from claim manager. Claim manager will authorize or deny.
Massage (MT)	Action required
Visits beyond first 6	Use the Massage Practitioner Treatment Authorization Fax Request (F248‑357‑000) form, or make a referral to the claim manager using the Provider Hotline 1‑800‑848‑0811.

For Self-Insured claims:

Contact the self-insured employer's claim manager.