Massage therapy provided by an LPN not licensed in massage therapy is nevertheless reasonable and necessary.
The claimant was injured at work in July of 1997. Later, the claimant settled the wage loss portion of his claim through a compromise and release agreement. However, medicals remained opened. The employer then requested utilization review concerning the reasonableness and necessity of medical treatment the claimant was receiving from a nurse, which included massage therapy.
The utilization review was performed by a licensed practical nurse. In her determination, she said that massage therapy does not fall within the scope of a licensed practical nurse. The nurse provider was certified in massage therapy but was not licensed for that. Therefore, it was determined that the massage therapy was not reasonable and necessary. The claimant challenged the determination by filing a petition. The Workers’ Compensation Judge granted the petition and found that the nurse provider was licensed as a practical nurse and that the massage therapy was being performed under orders from a licensed physician.
The employer appealed, and the Board reversed, concluding that in order for the cost of services to be payable under §306 (f) of the Act, it must be a medical service which the provider (a practical nurse) is licensed to provide. Because the provider was not licensed by the Commonwealth as a massage therapist, her services were not reimbursable under the Act.
The Commonwealth Court reversed the decision of the Board and granted the claimant’s appeal. The court pointed out that the nurse is a licensed health care provider under the Act, her services were prescribed by a physician, and the nurse asserted that she was trained in massage therapy. The nurse further stated that the massage therapy was something she utilized in providing therapeutic care to patients. The court held that the employer failed to establish that massage therapy did not come under the duties of an LPN.
Case Law Alert, 1st Quarter 2014