How do you handle authorization for physical therapy for a patient who is injured in a worker’s compensation injury?  We are going to get into real specifics here!

At our office, where we treat workers comp patients, we use the MG-2 form which is the “Attending Doctor’s Request for Approval of Variance”. A variance is needed when the patient needs more physical therapy than approved by the workers compensation “Medical Treatment Guidelines”.

Our office usually gets the request for authorization for variance request through fax. Workers compensation injury is specific to the body part. This means that the treating providers are allowed to treat only the injuries that are “approved”.

If a patient is injured and has a shoulder pain, we would put that body part (shoulder) on an MG-2 form. Each body part has a code that we use that we put on the MG-2 form for the specific body part the patient is going to get physical therapy for.

When filling out the MG-2 form, we place the doctor’s license number, NPI number, our telephone number, and our fax number. We also document specifically what we are requesting. What is the physical therapy for? For an example, if it were for a patient’s right shoulder, we would write physical therapy, right shoulder pain modalities/strengthening two to three times a week for 8 weeks.

After indicating the duration the physical therapy is requested and body part, we include the doctor’s last note and attach it to the MG-2 form. We place the date of service on the MG-2 form. We then have to obtain the correct fax number/email for the MG-2 form to be faxed. This fax number can be obtained by calling the patient’s adjuster and asking them what the fax number or alternative method to send the MG-2 or C4 authorizations.

Once we ascertain the correct fax number, we place that number on the form where it is indicated. The next part of the form includes the date that the MG-2 or C4 will be sent along with the doctor’s signature.

We then take the completed MG-2 along with the doctor’s notes. We fax the form with the notes to the adjuster as well as the worker’s compensation board.

We ensure the date we put on the authorization is the same date its faxed to the board and the adjuster. We ensure its faxed to the correct designated person. If this is not done the same day and to the correct contact, the MG-2 or C4 will get denied.

After the adjuster receives this request, they have 30 days to respond either yes or no. Once the adjuster has the form, there is nothing we can do to expedite the request.

When filling out a C4 form (Attending Doctor’s Request for Authorization and Carrier’s Response), we follow the same exact procedure as the MG-2.

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