Therapy Treatment

Physical and occupational therapy services are an integral component in the treatment of an injury. Treatment parameters and prior authorization guidelines are applicable for all therapy services.

If concerns arise during treatment of an injured worker, e.g. the injured worker not attending physical therapy, symptoms not consistent with the injury, cancellation of medical appointments, or noncompliance with treatment plan, contact Customer Service at 701-328-3800 or 800-777-5033.

Therapy Window Period and Authorization

Each claim has a window period and a post-op window period for treatment, with a separate window period allowed for physical and occupational therapy. There is one initial window period per claim, not per body part or diagnosis.

The therapy window period is:

  • 10 visits or 60 days of care, whichever comes first
    • Includes post-surgery(inpatient or outpatient), which must start within 90 days after the surgery
    • Includes post-manipulation window
  • Modalities are limited to 2 per visit
  • Treatment is limited to a maximum of 4 units per visit, including timed and/or non-timed codes
  • Prior Authorization is required for treatment extending beyond the window period

Therapy Authorization and Referrals includes detailed information on submitting a prior authorization request.