Michigan Workers' Compensation (WDCA - any carrier) Outpatient Physical Therapy prior authorization requirements (2026)
What Michigan Workers' Compensation (WDCA - any carrier) generally requires to approve Outpatient Physical Therapy (CPT 97161, 97162, 97163, 97164, 97110, 97112, 97113, 97116, 97124, 97140, 97150, 97530, 97535, 97542, 97750, 97760, 97761, 97010, 97012, 97014, 97032, 97035), for Workers Compensation (MI) plans. Based on the cited policy, Michigan Workers' Compensation (WDCA - any carrier) does not generally require prior authorization for Outpatient Physical Therapy (CPT 97161, 97162, 97163, 97164, 97110, 97112, 97113, 97116, 97124, 97140, 97150, 97530, 97535, 97542, 97750, 97760, 97761, 97010, 97012, 97014, 97032, 97035). Confirm with Michigan Workers' Compensation (WDCA - any carrier), as this can vary by plan.
Medical-necessity criteria Michigan Workers' Compensation (WDCA - any carrier) generally applies
No prior authorization is required by the Michigan Workers' Disability Compensation Act for outpatient PT (narrow exception: carrier-requested 99455 exams must be carrier-authorized). The employer/carrier must furnish reasonable and necessary care for a compensable work injury (MCL 418.315(1)); PT is reimbursable only when provided by a licensed PT (or PTA under PT supervision) PURSUANT TO A PRESCRIPTION. After 28 days from the start of care the employee may switch to a physician of their own choice on notice to the employer. Oversight is carrier-level retrospective utilization review against medically accepted standards under the Health Care Services rules (R 418.10101-418.101504): providers must submit records as a condition of payment; the carrier must pay, adjust, or reject a properly submitted bill within 30 days with an explanation of benefits; payment is capped by the annually updated RBRVS-based WDCA fee schedule; disputed/above-schedule amounts may NOT be balance-billed to the worker; reconsideration is available under R 418.101302. Physical-medicine documentation must support the restorative nature of treatment.
Commonly required documentation
- Prescription for PT
- evaluation and plan of care
- objective progress documentation supporting restorative treatment
- records submitted with bills per the HCS rules.
How to submit
- Method: Bill the workers' comp carrier directly; carrier responds within 30 days with an EOB
- Typical turnaround: about 30 days
Sources & verification
Sources: MCL 418.315 HCS Rules https://www.michigan.gov/leo/-/media/Project/Websites/leo/Documents/WDCA-HEALTHCARE/2025/R-41810101-to-R-418101504.pdf; 2025 fee manual https://www.michigan.gov/leo/-/media/Project/Websites/leo/Documents/WDCA-HEALTHCARE/2025/2025-Manual-final.pdf. Statewide rules - any WC carrier. [NEEDS CLINICAL SPOT-CHECK] View the source policy. Last verified 2026-07-09.
Frequently asked questions
Does Michigan Workers' Compensation (WDCA - any carrier) require prior authorization for Outpatient Physical Therapy?
Based on the cited policy, Michigan Workers' Compensation (WDCA - any carrier) does not generally require prior authorization for Outpatient Physical Therapy (CPT 97161, 97162, 97163, 97164, 97110, 97112, 97113, 97116, 97124, 97140, 97150, 97530, 97535, 97542, 97750, 97760, 97761, 97010, 97012, 97014, 97032, 97035). Confirm with Michigan Workers' Compensation (WDCA - any carrier), as this can vary by plan.
What does Michigan Workers' Compensation (WDCA - any carrier) require to approve Outpatient Physical Therapy?
No prior authorization is required by the Michigan Workers' Disability Compensation Act for outpatient PT (narrow exception: carrier-requested 99455 exams must be carrier-authorized). The employer/carrier must furnish reasonable and necessary care for a compensable work injury (MCL 418.315(1)); PT is reimbursable only when provided by a licensed PT (or PTA under PT supervision) PURSUANT TO A PRESC… Always confirm against the current Michigan Workers' Compensation (WDCA - any carrier) policy.
How long does a Michigan Workers' Compensation (WDCA - any carrier) prior authorization take?
Michigan Workers' Compensation (WDCA - any carrier) typically decides Outpatient Physical Therapy requests in about 30 days. Timeframes vary; check the payer portal.
Submitting Outpatient Physical Therapy to Michigan Workers' Compensation (WDCA - any carrier)?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.