Physical, Occupational and Chiropractic therapies are the cornerstone for healing for many injured workers. This function plays an important role in getting workers back on the job and feeling better.  Department of Labor & Industry posts Instruction sets for physical rehabilitation (see below for website links).  These should be used in conjunction with the Montana Utilization and Treatment Guidelines (U&T) at http://mtguidelines.com/.

Montana Professional Fee Schedule
https://mtwc.optum.com/documentations/2018ProfessionalFeeScheduleInstructionFinalafterRules.pdf

Montana Facility Fee Schedule
http://erd.dli.mt.gov/Portals/54/Documents/Work-Comp-Claims/Medical-Regs/FacilityFeeSchedules/FY2019/2018FacilityFeeScheduleInstructionSet.pdf.

Services should be within the Utilization and Treatment Guidelines at www.mtguidelines.com.

If a physical therapy/modality is not listed in the Utilization and Treatment Guideline (U&T) or goes over the maximum threshold, services must be pre-authorized by Montana State Fund.   Treatment should be directly related to the accepted part of body unless pre-authorized.

Timed Modalities (also applies to Facility services effective 7/1/2014) Services of less than 8 minutes when that is the only service performed during a visit is not billable. Time intervals are incremented in 15 minute units (base is 8 minutes):

8-22 minutes =             1 unit

23-37 minutes =           2 units

38-52 minutes =            3 units

53-67 minutes =           4 units etc

When more than one service of a timed modality is performed in a single day, the total minutes of the service performed should be included in the patient record to substantiate the level of service. A total of 8 units of active and passive therapy may be billed per visit.  If active therapy is being applied, only two units of a passive modality may be included in the 8 units.

Passive therapies (listed in U&T Guidelines) will be limited to 4 units per visit, if only passive therapy is being applied. Note:  Only 2 units may be billed if active therapy is being applied.

All timed codes must have the time documented (in minutes) in the office notes submitted for each code billed for reimbursement.

Therapy codes billed must have part of body documented or it must be clearly identified in a flow sheet or other attached documentation. If the procedures are clearly documented in the notes, a flow sheet is unnecessary. If the notes do not support the procedures billed but refers to a flow sheet then the flow sheet must be attached.

Passive vs Active

Passive modalities utilize a tool to cause an effect (i.e. electrical stimulation, hot/cold packs, iontophoresis, ultrasound, etc.).

Passive therapeutic procedures are procedures that do not require energy on the part of the patient (i.e. massage, manual therapy, etc.) and are considered with the active therapy for purposes of the rule of Eights.

Passive Modalities

Active/Passive Therapeutic Procedures: