4123-6-30 Payment for physical medicine.
(A) "Physical medicine" is the evaluation and treatment of a claimant by physical measures and the use of rehabilitative procedures, with or without assistive devices, for the purpose of preventing, correcting, or alleviating any work related disability. Physical medicine includes the establishment and modification of physical rehabilitation programs, treatment planning, instruction, and consultative services. "Physical measures" include massage, heat, cold, air, light, water, electricity, sound, manipulation, and the performance of tests of neuromuscular function as an aid to such treatment. Physical medicine does not include the diagnosis of a patient's disability, the use of roentgen rays or radium for diagnostic or therapeutic purposes, or the use of electricity for cauterization or other surgical purposes. Physical medicine includes, but not limited to, chiropractic treatments, physiotherapy, and physical therapy.
(B) Physical medicine must be prescribed by the physician of record or other approved treating provider licensed to practice medicine, osteopathy, chiropractic, mechanotherapy, dentistry, podiatry, or nursing
as a certified registered nurseanesthetist,clinical nurse specialist, certified nurse midwife, or certified nurse practitioner, or license to practice as a physician assistant. Physical medicine may be provided in the physician's office or referred to another licensed provider.(C) To be eligible for reimbursement, physical medicine services must be provided by a physician, chiropractic physician, physical therapist, occupational therapist, massage therapist, athletic trainer or other qualified non-physician provider practicing within the scope of his or her license, certification, or registration.
(D) Fees for up to twelve physical
therapymedicine treatments within sixty days following the date of injury may be reimbursed without prior authorization, provided the treatments are for allowed soft tissue and musculoskeletal conditions in allowed claims and the criteria set forth in paragraphs (B)(1) to (B)(3) of rule 4123-6-16.2 of the Administrative Code are met. Otherwise, physicaltherapymedicine treatment must be prior authorized.(E) Payment for physical medicine used for treatment of the allowed conditions shall be made in accordance with rule 4123-6-10 of the Administrative Code.
(F)
Physical medicine treatments must be provided in conjunction with:(1)In cases of temporary total disability, interim medical reports and medicaldocumentation meeting the requirements specified in paragraph (B) of rule4123-6-20 of the Administrative Code.(2)A current, written treatment plan meeting the requirements specified inparagraph (C) of rule 4123-6-20 of the Administrative Code.4123-6-30 2
Effective: 11/13/2015
Five Year Review (FYR) Dates: 08/26/2015 and 08/25/2020
CERTIFIED ELECTRONICALLY
Certification
11/02/2015
Date
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31, 4121.44,
4121.441, 4123.05, 4123.66
Rule Amplifies: 4121.12, 4121.121, 4121.44, 4121.441, 4123.66
Prior Effective Dates: 2/12/97, 2/1/10
Document Information
- Effective Date:
- 11/13/2015
- File Date:
- 2015-11-02
- Last Day in Effect:
- 2015-11-13
- Five Year Review:
- Yes
- Rule File:
- 4123-6-30_PH_FF_A_RU_20151102_1021.pdf
- Related Chapter/Rule NO.: (1)
- Ill. Adm. Code 4123-6-30. Payment for physical medicine