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State statutes or rules will sometimes limit by regulation the number of
treatments specified provider types can render to an injured worker
without additional authorization of the payor or the regulator. This
table covers some of those specific limitations on treatment for
specific providers or for specific types of care as of January 1, 2008. |
|
State |
Limitation on Evaluation and Management Services |
Limitation on Chiropractic Treatment |
Limitation on Physical Therapy |
Limitation on Occupational Therapy |
Limitation on Work Hardening |
Limitation on Psychotherapy |
Pre-authorization required for Spinal Surgery |
Other |
|
Sample State 1 |
None |
None |
None |
None |
None |
None |
No |
|
|
Sample State 2 |
None |
Per applicable Medical Treatment Guideline without prior authorization
(w/o prior authorization); or statutory if not Level I accredited |
One hr per day of procedures and two modalities per patient per
discipline of care per day w/o prior authorization |
One hr per day of procedures and two modalities per patient per
discipline of care per day w/o prior authorization |
6 hrs per day w/o prior authorization |
50 min/visit w/o prior authorization; 20 visits or 3 mos, whichever
comes first w/o prior authorization |
If non-emergency |
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Notes: |
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