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

he 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.