This page outlines what physical therapists need to know when serving as a primary treating provider for an injured employee.
Responsibilities of a Primary Treating Provider
Since August 1, 2021, a physical therapist may serve as the primary treating provider for an injured employee. An injured employee may only have one primary treating provider, who is responsible for managing their care.
Use the sections below to understand your responsibilities as a primary treating provider.
The primary treating provider has an important role in helping an injured employee stay at work or return to work as soon as medically reasonable and safe. Early in the course of treatment, the primary treating provider should discuss the healing process and expected recovery time with the injured employee. The primary treating provider should emphasize the positive role of activity on physical and psychological healing.
The primary treating provider is required to respond to letters and complete forms addressing questions regarding the injury.
The primary treating provider should document an injured employee’s abilities every 2 weeks, while the injured employee has work restrictions, or until they have reached Maximum Medical Improvement (MMI). The Capability Assessment (C3) form is a useful tool for this documentation. The injured employee should receive a copy of the C3 form to give to their employer to assist in job accommodation decisions.
Maximum Medical Improvement (MMI) is the point at which the injury will no longer improve with continued care. WSI relies on the primary treating provider's accurate and timely designation of MMI to guide claim management.
The primary treating provider may refer an injured employee for evaluation and/or treatment with another specialty (except mental health) without prior authorization from WSI.
If an injured employee requests treatment, it is important to understand the employer may already have a Designated Medical Provider (DMP). If so, the DMP is required to treat the injured employee, and any therapy treatment would require a referral from the DMP.
WSI considers an evaluation and re-evaluations medically necessary to:
- Complete an initial assessment
- Assess an injured employee's functional capabilities every 2 weeks
- Evaluate an injured employee with an exacerbated condition or condition failing to improve
- Evaluate an injured employee who has a lapse in care
A physical therapist may perform physical performance testing, i.e., a workability assessment, every 2 weeks to assess an injured employee’s functional capabilities. This assessment should include testing or measurements that evaluate an injured employee’s ability to complete specific tasks.
WSI does not require prior authorization for a workability assessment completed by a physical therapist serving as the primary treating provider. The workability is reimbursable under the following criteria:
- Performed no more than once every 2 weeks
- Does not exceed 3 units (>38 through 52 minutes)
- Billed using CPT® 97750