Title 907 | Chapter 008 | Regulation 025
907 KAR 8:025.Physical therapy service reimbursement provisions and requirements.
Section 1.
General Requirements. For the department to reimburse for physical therapy under this administrative regulation, the:(1)
Physical therapist shall meet the provider requirements established in 907 KAR 8:020; and(2)
Physical therapy shall meet the coverage and related requirements established in 907 KAR 8:020.Section 2.
Reimbursement.(1)
The department shall reimburse for a physical therapy service provided by a:(a)
Physical therapist, in accordance with 907 KAR 8:020 and this section, at 63.75 percent of the rate for the service listed on the current Kentucky-specific Medicare Physician Fee Schedule; or(b)
Physical therapist assistant working for a physical therapist, in accordance with 907 KAR 8:020 and this section, at 37.5 percent of the rate for the service listed on the current Kentucky-specific Medicare Physician Fee Schedule.(2)
(a)
The current Kentucky-specific Medicare Physician Fee Schedule shall be the Kentucky-specific Medicare Physician Fee Schedule used by the Centers for Medicare and Medicaid Services on the date that the service is provided.(b)
For example, if a physical therapy service is provided on a date when the Centers for Medicare and Medicaid Services':1.
Interim Kentucky-specific Medicare Physician Fee Schedule for a given year is in effect, the reimbursement for the service shall be the amount established on the interim Kentucky-specific Medicare Physician Fee Schedule for the year; or2.
Final Kentucky-specific Medicare Physician Fee Schedule for a given year is in effect, the reimbursement for the service shall be the amount established on the final Kentucky-specific Medicare Physician Fee Schedule for the year.Section 3.
Not Applicable to Managed Care Organizations. A managed care organization shall not be required to reimburse in accordance with this administrative regulation for a service covered pursuant to:(1)
907 KAR 8:020; and(2)
This administrative regulation.Section 4.
Federal Approval and Federal Financial Participation. The department's reimbursement for services pursuant to this administrative regulation shall be contingent upon:(1)
Receipt of federal financial participation for the reimbursement; and(2)
Centers for Medicare and Medicaid Services' approval for the reimbursement.Section 5.
Appeal Rights. A provider may appeal an action by the department as established in 907 KAR 1:671.HISTORY: (40 Ky.R. 2048; 2550; 2768; eff. 7-7-2014; Crt eff. 12-6-2019.)
907 KAR 8:025.Physical therapy service reimbursement provisions and requirements.
Section 1.
General Requirements. For the department to reimburse for physical therapy under this administrative regulation, the:(1)
Physical therapist shall meet the provider requirements established in 907 KAR 8:020; and(2)
Physical therapy shall meet the coverage and related requirements established in 907 KAR 8:020.Section 2.
Reimbursement.(1)
The department shall reimburse for a physical therapy service provided by a:(a)
Physical therapist, in accordance with 907 KAR 8:020 and this section, at 63.75 percent of the rate for the service listed on the current Kentucky-specific Medicare Physician Fee Schedule; or(b)
Physical therapist assistant working for a physical therapist, in accordance with 907 KAR 8:020 and this section, at 37.5 percent of the rate for the service listed on the current Kentucky-specific Medicare Physician Fee Schedule.(2)
(a)
The current Kentucky-specific Medicare Physician Fee Schedule shall be the Kentucky-specific Medicare Physician Fee Schedule used by the Centers for Medicare and Medicaid Services on the date that the service is provided.(b)
For example, if a physical therapy service is provided on a date when the Centers for Medicare and Medicaid Services':1.
Interim Kentucky-specific Medicare Physician Fee Schedule for a given year is in effect, the reimbursement for the service shall be the amount established on the interim Kentucky-specific Medicare Physician Fee Schedule for the year; or2.
Final Kentucky-specific Medicare Physician Fee Schedule for a given year is in effect, the reimbursement for the service shall be the amount established on the final Kentucky-specific Medicare Physician Fee Schedule for the year.Section 3.
Not Applicable to Managed Care Organizations. A managed care organization shall not be required to reimburse in accordance with this administrative regulation for a service covered pursuant to:(1)
907 KAR 8:020; and(2)
This administrative regulation.Section 4.
Federal Approval and Federal Financial Participation. The department's reimbursement for services pursuant to this administrative regulation shall be contingent upon:(1)
Receipt of federal financial participation for the reimbursement; and(2)
Centers for Medicare and Medicaid Services' approval for the reimbursement.Section 5.
Appeal Rights. A provider may appeal an action by the department as established in 907 KAR 1:671.HISTORY: (40 Ky.R. 2048; 2550; 2768; eff. 7-7-2014; Crt eff. 12-6-2019.)