WSR 26-04-112
PROPOSED RULES
DEPARTMENT OF
LABOR AND INDUSTRIES
[Filed February 3, 2026, 8:18 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 25-23-071.
Title of Rule and Other Identifying Information: Reimbursement policies: WAC 296-21-290 Physical medicine, under chapter 296-21 WAC, Reimbursement policies: Psychiatric services, biofeedback, physical medicine.
Hearing Location(s): On March 10, 2026, at 2:30 p.m., virtual and telephonic hearing. Join electronically at https://lni-wa-gov.zoom.us/j/83456839926?pwd=w6fAaq1wnlcwGTILbWtlzDcamVBtxn.1, Meeting ID 83456839926; or join by phone (audio only) 253-205-0468 US, 253-215-8782 US (Tacoma). The hearing will begin at 2:30 p.m. and will continue until all oral comments are received.
Date of Intended Adoption: May 5, 2026.
Submit Written Comments to: Marc Hobbs, Department of Labor and Industries (L&I), Insurance Services, Health Services Analysis, P.O. Box 44322, Olympia, WA 98504-4322, email Marc.Hobbs@Lni.wa.gov, fax 360-902-4249, beginning February 4, 2026, at 8:00 a.m., by March 10, 2026, at 5:00 p.m.
Assistance for Persons with Disabilities: Contact Marc Hobbs, phone 360-902-4244, fax 360-902-4249, email Marc.Hobbs@Lni.wa.gov, by March 3, 2026.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: This rule making will: (1) Add chiropractors and occupational therapists to the types of providers who may perform and be paid for physical medicine services; and (2) restructure the rule text for improved clarity, readability, and precision.
Making this change will bring the rule into alignment with current policy regarding occupational therapists, who may already perform physical medicine services for workers. It will also enable chiropractors to bill for physical medicine services beyond the context of being an attending provider on the claim.
Reasons Supporting Proposal: Occupational therapists and their assistants are already allowed in policy to perform physical medicine services. Adding them to this rule codifies their role and brings the rule into alignment with current practices.
Adding chiropractors as a type of provider who may perform and bill for physical medicine services offers multiple benefits. Chiropractors have the scope of practice, education, and training necessary to do physical medicine work, so they will be able to offer services comparable to those offered by other physical medicine providers, such as physical therapists or physiatrists. Allowing chiropractors to bill for physical medicine will expand access to conservative medical care for workers. Faster access to care reduces healing time and gets workers back to work sooner, which results in better health outcomes.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: L&I, governmental.
Name of Agency Personnel Responsible for Drafting: Marc Hobbs, Tumwater, Washington, 360-902-4244; Implementation and Enforcement: Brenda Heilman, Tumwater, Washington, 360-902-4997.
A school district fiscal impact statement is not required under RCW
28A.305.135.
A cost-benefit analysis is required under RCW
34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Marc Hobbs, L&I, Insurance Services, Health Services Analysis, P.O. Box 44322, Olympia, WA 98504-4322, phone 360-902-4244, fax 360-902-4249, email
Marc.Hobbs@Lni.wa.gov.
This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal:
Is exempt under RCW
19.85.025(3) as the rules only correct typographical errors, make address or name changes, or clarify language of a rule without changing its effect.
Scope of exemption for rule proposal:
Is partially exempt:
Explanation of partial exemptions:
| Proposed WAC Sections and Title | This proposed rule section is not exempt - Analysis is required. | This proposed rule section is exempt. Provide RCW to support this exemption. |
1 | WAC 296-21-290, Physical medicine: Subsection (1) | X | |
2 | WAC 296-21-290, Physical medicine: Subsection (2) | X | |
3 | WAC 296-21-290, Physical medicine: Subsection (3) | ☐ | RCW 34.05.328 (5)(b)(iv) Housekeeping. Changes clarify language by consolidating multiple references and redundancies into a single subsection without changing the effect of the rule. |
4 | WAC 296-21-290, Physical medicine: Subsection (4) | ☐ | RCW 34.05.328 (5)(b)(iv) Housekeeping. Changes add a subsection number and clarify language by cleaning up wording without changing the effect of the rule. |
5 | WAC 296-21-290, Physical medicine: Subsection (5) | X | |
6 | WAC 296-21-290, Physical medicine: Subsection (6) | ☐ | RCW 34.05.328 (5)(b)(iv) Housekeeping. Changes add a subsection number and clarify language by cleaning up wording without changing the effect of the rule. |
The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. The proposed rule is not expected to significantly alter claim costs. Enabling chiropractors to perform physical medicine will not increase the overall number of visits a worker can receive for physical medicine services; instead, visits with a chiropractor for this purpose will replace those that would have otherwise happened with a physical therapist. The overall number of visits will remain mostly the same, and chiropractors will be paid at the same daily rate as physical and occupational therapists, so their services will not cost more. Additionally, by providing access to chiropractors for physical medicine, workers will have a wider selection and shorter wait times to receive care. Increasing access to care reduces delays in medical treatment and time loss payments, resulting in reduced claim costs and helping workers heal and return to work more quickly, which leads to overall cost savings.
February 3, 2026
Joel Sacks
Director
RDS-6919.3
AMENDATORY SECTION(Amending WSR 25-11-071, filed 5/20/25, effective 7/1/25)
WAC 296-21-290Physical medicine.
(1) ((Whom does the department authorize and pay for physical medicine or physical therapy services?)) The department or self-insurer may authorize and pay for physical medicine services from the following providers:
((•))(a) A medical or osteopathic physician who is (("))board certified or board qualified((")) in the field of physical medicine and rehabilitation (physiatrist); or
((• A licensed))(b) A physical therapist; or
((•))(c) An occupational therapist; or
(d) A chiropractor; or
(e) The injured worker's attending provider((, within)).
(i) For purposes of this section, "attending provider" means a provider who is not a physiatrist, physical therapist, occupational therapist, or chiropractor.
(ii) Attending providers are subject to the limitations listed ((below))in subsections (4), (5), and (6) of this section.
(2) The physical medicine services must be ((personally)) performed by ((the:
• Physical medicine and rehabilitation physician; or
• Attending provider; or
• Licensed))a:
(a) Physiatrist; or
(b) Physical therapist; or
((• Physical therapist))(c) Occupational therapist; or
(d) Chiropractor; or
(e) Attending provider; or
(f) Physical therapy assistant employed by and serving under the direction of a ((
licensed physical therapist, physical medicine and rehabilitation physician))
physiatrist, physical therapist, chiropractor, or attending provider as required ((
in))
by RCW
18.74.180 (3)(a); or
((
• Licensed))
(g) Occupational therapy assistant employed by and serving under the direction of an occupational therapist as required by RCW 18.59.020(6); or(h) Athletic trainer employed by and serving under the direction of a ((
licensed physical therapist, physical medicine and rehabilitation physician))
physiatrist, physical therapist, chiropractor, or attending provider as required ((
in))
by RCW
18.250.010 (4)(a)(v).
((Note: | Licensed physical therapy provider rules are contained in chapter 296-23 WAC. |
(2) When may the department or self-insurer pay the attending provider for physical medicine services?))(3) The codes, reimbursement rates, and other policies for physical medicine services are listed in the department's Medical Aid Rules and Fee Schedules, and all payments will be made in accordance with these fee schedules and payment policies.
(4) The department or self-insurer may pay the attending provider to provide physical medicine ((modalities and/or procedures in the following situations))services if both the following criteria are met:
(a) The attending provider's scope of practice includes physical medicine modalities and procedures((.)); and
(b) ((Only the physical medicine modalities and procedures allowed))The physical medicine services performed are covered under the department's fee schedules and payment policies ((will be authorized or paid)).
(((c)))(5) No more than six physical medicine visits may be authorized and paid to the attending provider.
(a) If the worker requires treatment beyond six visits, the worker must be referred to a ((licensed))physiatrist, physical therapist ((or a board certified or qualified physical medicine and rehabilitation physician)), occupational therapist, or chiropractor for such treatment. ((Payments will be made in accordance with the department's fee schedules and payment policies.
(d)))(b) In remote areas((,)) where no ((physical medicine and rehabilitation specialist, licensed))physiatrist, physical therapist ((or physical therapist assistant)), occupational therapist, or chiropractor is available, physical medicine visits required ((by))to treat the worker's accepted condition(s) may be authorized and paid to the attending provider. ((Payments will be made in accordance with the department's fee schedules and payment policies.
(e)))(6) The attending provider may bill for ((office visits))physical medicine services in addition to ((the physical medicine services))an office visit only when a separately identifiable ((office visit))physical medicine service is provided in addition to the ((physical medicine service.
(3) What codes and fees are payable for physical medicine services?
• The codes, reimbursement levels, and other policies for physical medicine services are listed in the department's Medical Aid Rules and Fee Schedules. Physicians licensed in physical medicine and licensed physical therapists use CPT and/or HCPCS codes, rules and payment policies as listed in the department's Medical Aid Rules and Fee Schedules or provider bulletins.
• Attending providers must use the local codes, rules and payment policies published in the department's Medical Aid Rules and Fee Schedules or provider bulletins))office visit.