U & T Guidelines: Physical Therapy – When the Threshold is Not Enough
The Montana Utilization and Treatment Guidelines (adopted effective 7/1/11, ARM 24.29.1591 – 24.29.1599) by the Montana Department of Labor and Industry established guidelines for providing treatment for primary and secondary medical services based on the injured part of body including chronic regional pain syndrome and chronic pain disorder. All health care providers must use these guidelines when treating an injured worker.
When physical therapy services are needed beyond the duration and frequency limits set out in the Guidelines, providers must obtain prior authorization pursuant to MCA 39-71-704 and in accordance with ARM 24.29.1593. For MSF injured workers, a provider may request additional treatment by completing and submitting the Therapy Precert Request form for approval. Information must include the proposed treatment plan, measurable functional goals and any work recommendations. This form may be downloaded at montanastatefund.com. Click on the I am a Medical Provider tab, then click Provider Resources, scroll down and you will find the Therapy Precert Request form.
After completing the form, please Fax to 1-800-495-5020. The claims examiner assigned to the injured worker will approve or disapprove the request and fax the determination back to the provider.