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; or

2.

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.)

7-Year Expiration: 12/6/2026

Last Updated: 12/15/2021


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