Presumptive authorization

For dates of injury on or after Nov. 1, 2002, BWC extended presumptive approval to provide services from the first 45 days following an injury to the first 60 days following an injury.

For a period not to exceed 60 days following the date of injury, physicians have presumptive authorization to provide the following services when treating soft tissue and musculoskeletal injuries that are allowed conditions in claims:

• Ten physical medicine visits, including osteopathic, chiropractic, physical therapy, occupational therapy and transitional work on-site therapy services;
• Diagnostic studies, including X-rays, CAT scans, MRI scans and EMG/NCV;
• Injections, up to three soft-tissue or joint injections (does not include epidural injections);
• Evaluation/management services and consultation services.

The following criteria must be met before initiating any or all of the above services:

• The provider will file the FROI with the managed care organization (MCO);
• The provider will complete and file the Physician’s Request for Authorization of Medical Services or Recommendation for Additional Conditions for Industrial Injury or Occupational Disease (C-9) with the MCO. MCOs notify providers within three business days that they received the C-9, and reviewed it to ensure that services being rendered are medically necessary for the claim allowance;
• The provider shall notify the MCO within 24 hours of treatment if the injured worker will be off work for more than two calendar days.