Community treatments

Acupuncture is an alternative medical treatment that can be administered independently by a licensed acupuncturist, or by a physiotherapist, chiropractor, or physician who is certified to practice acupuncture by their governing regulatory body.

The contracted treatment is up to a maximum of seven (7) acupuncture treatments over a four week period including the combined assessment and first treatment. 

When acupuncture is performed as part of routine physiotherapy or chiropractic care, whether by the same or different practitioners in the same facility, the provider is not permitted to bill separately for acupuncture on top of the standard physiotherapy or chiropractic charges. 

If a patient receives chiropractic care at one clinic and acupuncture at another, this must be reviewed as concurrent care and pre-approved by the WCB.

Acupuncture is not an approved treatment for psychological injures. Refer to the internal Addendum 40.1E - Medical Services Not Normally Authorized.  

Initial treatment request

Document the treatment decision in eCO, and communicate the decision in writing to the provider, worker and employer.  In the letter, include the date range of the treatment authorized or an explanation when the treatment is not approved or indicated that further review is required to make the decision.  

When treatment is approved, authorize one assessment (including treatment) and up to seven acupuncture treatments over a four-week period. 

Treatment extension request

When a request is made to extend treatment beyond the standard initial number of sessions, refer the recommendation to a physiotherapy (PT) consultant, if the report was not sent to the PT fax line. The provider must submit the report after the first five visits, detailing the worker’s status, objective findings and the requested number of additional treatments. Treatment authorization should not be extended while waiting for the PT consultant's review.  

Review the report for the extension request. If the report is stamped with “received to the PTC” it is in the queue for review. However, if it is not stamped, refer the claim to the PT consultant for review of the extension request. 

The PT consultant will document the period of authorization for the extension request in a file note and will fax a response to the provider. 

Review the PT consultant's recommendation and action accordingly. 

In the letter, include the date range of the treatment authorized or an explanation when the treatment is not approved or indicate that it is pending further review.  

Chiropractic care offers workers an active, functional approach to treating compensable injuries. It emphasizes active exercise tailored to the physical demands of the worker's job. This care includes specific adjustment and manipulation techniques and may be performed alone or in conjunction with acupuncture. 

The contracted treatment period is 22 treatments over six-weeks, including the combined assessment and first treatment. Refer to the additional considerations and guidelines noted below.

Initial treatment request

Upon receipt of the Chiropractor's First Report (C-056), document the treatment decision via the Approval Exception Pending (Benefit) task for contracted providers, or by completing the Benefit Details screen for non-contacted providers. Confirm the dates are correct. 

If the worker and employer are not automatically notified of the decision, send the appropriate letter. Include the date range of the treatment authorized or an explanation when the treatment is not approved or pending further review.

Treatment extension request

Chiropractic treatment cannot continue beyond the authorized period without additional approval. All requests to extend treatment are reviewed by the internal chiropractic consultant.

When the Chiropractor's Progress/Discharge report (C352) is submitted, and treatment is requested beyond the approved period of treatment, a taskC352 Treat Extenion Beyond Auth Timefram Req task is sent to the chiropractor consultant for review. When the report is received through RapidReport, the task provides the extension period requested, in all other cases, it does not.  

The chiropractic consultant reviews the report and documents a recommendation for extending the treatment period or an alternate treatment plan in a file note. 

Review the chiropractic consultant's recommendation and action as required. Document the decision in eCO based on the task received. 

Contact the worker to discuss the additional treatment or alternate plan, including any recommendations from the chiropractic consultant.

If an alternate plan is recommended and treatment is not extended, contact the provider and the worker to explain the reason. Communicate the decision in writing. 

Additional considerations

All chiropractors at an authorized clinic are considered authorized providers.

Effective January 1, 2025, WCB will not pay for x-rays completed within a chiropractic office. If a chiropractor requires x-rays for treatment planning, they can provide the worker a requisition to have the x-rays completed at a diagnostic service provider.

When acupuncture is provided alongside chiropractic treatment, whether by one or two separate practitioners in the same clinic, it is considered part of the chiropractic service. As a result, the clinic cannot bill for both services separately. 

If a worker is wanting to receive chiropractic care at one clinic and acupuncture at another, or chiropractic care and physiotherapy at the same time, this must be reviewed as concurrent care and pre-approved by the WCB. 

Chiropractors are not authorized by the WCB to provide customized braces or orthotics to workers. If a chiropractor recommends an item such as an orthotic or appliance for a worker, they should notify the decision maker who can make a referral to a WCB-authorized prosthetics and/or orthotics provider. Chiropractors cannot be paid for these items as they are not within the scope WCB approval.

Note: When the WCB requires a summary of clinical information that requires the chiropractor to extract and report information related to a work-related injury, a fee will be paid for the reporting with the amount based on whether an opinion was also requested. 

Non-contracted providers

Ensure the service rates have been verified for the non-contracted Alberta providers, and that they have been approved to treat the worker by the health care consultant (refer to step 1). 

Sundry items

Chiropractors can supply various (sundry) items to workers to aid their treatment and recovery of their work-related injury. The approvable items and associated fees are detailed in the WCB Chiropractic Fee for Service document. Typically, only one or two items are provided throughout the treatment. Feespayment code - TOP/NOP MS40 are paid directly to the clinic. 

The following items must be pre-approved by the decision maker:

• Wobble board
• Chair support
• Other items that are not included in the document
• Fees exceeding the amounts listed in the WCB Chiropractic Fee for Service document
• When the cumulative cost of the sundry items exceeds $100

The payment of sundry items does not affect the amount authorized for chiropractic treatment.

Supportive chiropractic care 

Supportive chiropractic care may be necessary for patients who, despite rehabilitative exercises and other lifestyle modifications, are unable to sustain therapeutic gains after the conclusion of a standard course of chiropractic treatment.

Eligibility

Supportive care will only be considered when all of the following conditions apply:

1. Treatment will allow the worker to stay at work and is necessary to ensure the worker’s condition does not deteriorate;
2. Objective findings suggest the worker’s condition has plateaued;
3. Treatment is specific to the healing injury or the specific body areas most affected by the compensable injury; and
4. The worker is working at the time treatment is being provided and proof of employment has been obtained. However, consideration may be given to workers who are actively seeking employment or are enrolled in a WCB-authorized re-employment services program (e.g., Supported job search, retraining program, etc.).

Authorization

• The request for supportive care must be submitted on the Chiropractic Progress/Discharge Report (C-352) and include a start and end date and indicate the frequency of treatment. In general, no more than one or two treatments per month will be authorized. Best efforts must be made to help the worker self-manage their condition and reduce their reliance on supportive chiropractic care.
• Progress reports and invoices must be submitted to WCB every three months for the period authorized. Refer to the General tab in the Supporting References section for a link to the Chiropractic fees document on the WCB website.
• Supportive care must be reviewed by the WCB chiropractic consultant to determine the frequency and duration of treatment, and authorized by a WCB case manager. In addition, requests for supportive care must be reviewed annually by the chiropractic consultant to determine ongoing need and eligibility.

Eligibility

Outpatient physiotherapy and occupational therapy services may be provided by hospitals when: 

• The worker lives in a rural area where there is no WCB contracted community physiotherapy or occupational therapy provider within a reasonable commute of the worker.
  • If community treatment is available within a reasonable commute, refer the worker to an authorized WCB physiotherapy community provider.
• The worker (regardless of where the live) has one of the following special circumstances:
  • Complex injury
  • Complex hand injury, including some post-surgical protocol
  • Wound management

Discuss appropriate treatment options with the worker when outpatient PT or OT may be required. 

Outpatient physiotherapy treatment should be authorized based on the contract standard for treatment and reporting. 

Outpatient occupational therapy services can be authorize for splinting of hand injuries and when the worker lives in a geographic area where there is no authorized community occupational therapy provider with a specialty in hand therapy/splinting. Treatment is authorized as follows:

• One initial splinting visit and up to a maximum of four follow-up visits over a maximum of six consecutive calendar weeks can be provided without authorization. For continued treatment beyond these visits, obtain approval from the appropriate health care consultant.
• Serial casting requires advance authorization from an OT consultant.
• WCB pre-authorizes occupational therapy treatment for up to a maximum of 12 visits over 12 consecutive calendar weeks for the management of Mallet finger or Boutonniere deformity injuries to accommodate specific physician protocols. For continued treatment beyond these visits, obtain approval from the appropriate health care consultant. 

Contact an OT consultant for questions regarding approval of treatment. 

Complex injuries

• Hospitals are authorized to provide outpatient physiotherapy and occupational therapy treatment for complex injuries.
• Hospitals are authorized to provide concurrent care for the following complex conditions:
  • Burns requiring debridement
  • Significant traumatic brain injury
  • Spinal cord injuries
  • Amputations involving at least one major joint (excluding fingers)
  • Motor nerve paralysis of the upper limb
  • Re-implantation of a limb or digit(s)
• Because of the severity of the injury, hospitals can start treatment without authorization. If the treatment is not accepted, notify the hospital in writing as soon as possible.

Hand injuries 

• Hospitals are authorized to provide outpatient treatment for hand injuries or surgeries. Hand Clinic treatment can be provided by a physiotherapist or an occupational therapist.
• Only authorize the hospital to provide treatment for the following hand injuries (hand injuries are defined as distal to (below) the wrist joint:
  • Intra-articular hand fractures
  • Multiple fractures requiring open reduction and internal fixation
  • All post-surgical cases of the hand involving ligaments and tendons
  • Volar plate disruption
  • Significant crush injuries (excluding distal phalynx)
• Examples of conditions where treatment at a hospital will not be authorized by the WCB are:
  • Carpal tunnel syndrome and/or release
  • Single digit extra-articular fractures
  • De Quervain's tenosynovitis and/or release
  • Trigger finger release
  • Ulnar nerve transposition/release
  • Distal phalanx crush/amputation

 Hospital post-surgical protocols 

• If available, follow the operating surgeon's post-operative rehabilitation protocol (to be faxed to the WCB along with the Assessment report). Only an official typewritten protocol should be accepted.
• If a protocol is not available, authorize treatment using the following time frames: 

WCB Hospital Post-Surgical Hand Protocols

Wound management

• Due to the severity of the injury, hospitals can start treatment without authorization. If the treatment is not approved, notify the hospital in writing as soon as possible.
• Treatment for open wound management can be provided without authorization for up to a maximum of three weeks. Continuation beyond three weeks requires approval from the physiotherapy consultant. 

Treatment extension request

Extensions of hospital treatment follow the same process as all physiotherapy extension requests. Extensions of hospital treatment beyond authorized time frames require approval from a PT consultant. Claim owners may not authorize extensions of hospital treatment, and hospitals are not authorized to automatically extend treatment. All extension requests must be made on a status report and faxed to the Physical Therapy Consultant fax line at (780) 498-3226. They will review and provide a faxed response to the provider (C815) within three business days. 

Extension requests must be submitted no earlier than five business days before the completion of the authorized treatment period. Requests will not be considered if the worker has:

• returned to full pre-accident work duties.
• not improved with treatment or requires a referral to a WCB authorized Return to Work Centre.

Fees for all services will follow the current Inter-Provincial Agreement rate for outpatient visits as directed by Alberta Health.

• Cancellations or absences from treatment shall not be funded by the WCB.
• Extra treatments will not be added to the program to make up for absences.
• Report fees are included in the outpatient visit rate.
• Concurrent physiotherapy and occupational therapy will be billed as one visit only. Report fees will not be issued.

Occupational therapists guide and support workers receiving treatments, including exposure and cognitive therapies, in the community. 

Cognitive and exposure therapy are two therapeutic approaches within the larger group of cognitive behavioral therapies. 

Exposure therapy is used in the treatment of disorders including generalized anxiety, social anxiety, post-traumatic stress and phobias. In exposure therapy, workers are exposed to fears within a safe environment with the goal of reducing or eliminating the escape response. Cognitive therapy can be helpful to those dealing with thinking, learning and memory problems due to a brain injury or concussion. 

When determining whether a request for exposure or cognitive therapy is related to the work injury, call the worker to discuss their concerns and the supports available to them. Use information from the conversation to determine whether the treatment is appropriate.

When the request is approved, authorize up to 18 hours (72 units) of treatment.

Initial treatment request

Document the decision in eCO, and communicate it in writing to the provider, worker and employer.

Monitor the progress of the worker’s treatments

The provider is required to submit a report within five business days of the initial appointment, followed by a progress report every four weeks and a discharge report within five business days of final appointment. 

Collaborate with the provider and worker to create a cooperative plan. 

Contact the provider, worker and/or a member of Health Care Strategies if there are concerns or to discuss the worker’s progress and return to work. Cooperate to resolve any issues that arise. 

Treatment extension request

The provider may submit a request to extend treatment beyond the standard initial number of sessions. Call the service provider to discuss the extension, treatment goals and progress to determine how close the worker is to meeting their goals.

The decision maker can approve up to five hours of extended treatment for a maximum total of 23 hours (92 units) of treatment. Requests beyond the maximum number of hours must be submitted to the occupational therapy consultants to review and make recommendations. Review the recommendations and notify the occupational therapy consultant of the decision. 

Note: If a change in provider is required, for any reason, re-start the process back at step 1. 

When the treatment extension is approved, continue to monitor the worker’s progress.

When the treatment extension is not approved, discuss any alternate recommendations made by the Health Care Consultant or offer additional resources for support.

Physiotherapy (PT) is intended to provide workers with an active sports medicine approach to treatment and recovery. Emphasis is placed on active functional exercise, education in pain control, self-management of the injury, and prevention of re-injury.

Physiotherapy may be performed in a physiotherapy clinic, community health centre or as part of a hospital-based program. Whether contracted or non-contracted, the authorized provider follows the contract standard for treatment and reporting. Non-contracted providers are not normally aware of the contract requirements following the initial authorization phase. Refer to the non-contracted provider section below for further information. 

Standard authorization (phase information):

Phase one: Standard initial authorization:

• The number of treatments and length of period depends on the type of injury:
  • For soft tissue injuries, concussion, and non-fractures and non-surgical injuries, the decision maker authorizes up to 8 treatments over 4 weeks.
  • For fracture and surgical injuries, the decision maker authorizes up to 16 treatments over 8 weeks.
• Initial 8 or 16 treatments includes the date of assessment and first treatment.
• Abbreviated progress report expected at week 2 or week 4 for fracture and surgical injuries.

If the surgeon’s protocol differs from the WCB's, the surgeon’s protocol will be followed only after the physiotherapist provides a copy to the WCB. Only an official typewritten protocol should be accepted.

Note: If the worker has sustained one of the injuries listed below, post-surgical treatment may be required beyond the standard initial authorization period (8 weeks). Contact the treating provider to discuss the surgeon's protocols and treatment plan. 

• Shoulders: Arthroscopic rotator cuff repair, open/mini-open rotator cuff repair, total shoulder replacement
• Knees: ACL reconstruction, quads/patellar tendon repair
• Elbows: Distal biceps repair, elbow release with ECRB transfer
• Hands: Flexor/ extensor tendon repairs (digits 2-5)
• Fractures: unstable pelvic fracture or patella requiring surgery.

A PT consultant review or RTW assessment is required before an extension of community physiotherapy can be approved.

Initial treatment request 

Upon receipt of one of the Physiotherapy Assessment Reports (C-533, C-533P or C-313), Hospital Hand Clinic Assessment Report (C-829) or a Hospital Occupational Therapy Assessment Report (C-826), confirm the dates are correct based on the standard 4 or 8 week period, or longer if the surgeon provided a specific fracture or surgical protocol. Document the treatment decision via the Approval Exception Pending (Benefit) task for contracted providers, or by completing the Benefit Details tab for non-contacted providers. 

If the worker and employer are not automatically notified of the decision, send the appropriate letter. Include the date range of the treatment and advise that extension requests must be pre-approved. Provide an explanation if the decision is to deny treatment or it requires further review before a decision can be made. 

Review the reporting and determine the next step (discharge, assessment or treatment extension) 

As of January 1, 2025, any extension beyond the initial authorized period (4 weeks, 8 weeks or the surgeon's fracture or surgical protocol), needs to be pre-approved by the PT consultant or through a return to work assessment. 

Contracted provider:

At the end of the initial authorized period, review the reporting and the treating physiotherapist's recommendation: 

• If the worker has returned to their date-of-accident fitness level or the treatment goals will be achieved over the next 4 weeks, the treating physiotherapist will discharge the worker. They may offer up to 4 transitional visits in the 4 weeks following the worker's discharge to support their return to work and transition to a self-managed home program. This is not considered an extension request. Update the care plan and send the appropriate care plan letter, as required.
• If the worker is not working, the physiotherapist will recommend a return to work assessment (RTWA), such as: a medical status exam, shoulder or back medical exam, functional capacity evaluation etc.
  • Contact the worker to discuss the assessment referral. Advise that, one interim visit per week is approved while waiting for the assessment results.
  • Send the referral.
  • Monitor for the assessment results. When received, update the care plan and send the appropriate care plan letter, based on the recommendations. Continue to manage the care plan.
• If the physiotherapist determines the worker is not ready (medically) for a return to work assessment, or more than an additional 4 weeks of physiotherapy is required, they will recommend the treatment be extended.
  • Up to 1 interim visit per week can be provided while waiting for approval for the treatment extension request.
  • A Treatment Extension Requested on PT report task is sent to the Physical Therapy Consultant (PTC), Team Desk and should only be actioned by a PTC.  
  • The PT consultant reviews the report and relevant claim information, and sends a file note to the decision maker with their recommendations. Refer to the Treatment extension requests and documentation information below. 

The decision maker may refer the worker for other assessments/services when appropriate and can use their available resources to make that determination. If the assessment/services differ from the physiotherapist's recommendations, communicate the decision to the worker, employer and provider. Refer to the 4-1 Medical testing, referrals and program support procedure for assistance with deciding when to refer a worker to a RTW Centre. 

Non-contracted provider:

When authorized to treat an individual worker, non-contracted physiotherapy clinics and hospital physiotherapy clinics/community health centres should follow the contract standard for treatment and reporting. All requests for additional treatment must be approved through the physiotherapy consultant.

The decision maker may refer the worker for other assessments/services when appropriate and can use their available resources to make that determination. Refer to the 4-1 Medical testing, referrals and program support procedure for assistance with deciding when to refer a worker to a RTW Centre. 

At the end of the initial authorization period, the non-contracted treatment provider may, discharge the worker, request an extension of treatment or recommend an alternate plan (e.g., additional investigations or consultations etc.). If the physiotherapist requests an extension of treatment, refer the extension request to the PT consultant for review, if the report was not sent to the PT fax line. If the report is stamped with “received to the PTC” it is in the queue for review. However, if it is not stamped, refer the claim to the PT consultant. 

Follow the treatment extension process below. In the letter, include the date range of the treatment authorized or an explanation when the treatment is not approved or indicate it is pending further review.  

Continue to monitor the worker's treatment. Return to step 5. 

Treatment extension request

Treatment extensions are only approved when there is evidence the worker is progressing towards their fitness to return to work as outlined in the care plan, the ongoing reason for treatment is directly related to the compensable injury, or the worker is not ready (medically) for a referral to another service or program.  The PT consultant determines whether it is appropriate to extend the treatment. When further community physiotherapy is approved, the treatment moves to phase 2. 

Phase two: Treatment Extension:

• The length of period depends on recommendations from the PT consultant.
• Physiotherapist can treat up to 2x per week.
• Comprehensive reporting is expected every 3 weeks until discharge.

Review and action the PT consultant's recommendations. If treatment is extended, they will outline the length of the extension. Document the decision in eCO based on the task received. 

Contact the worker to discuss the additional treatment or alternate plan including any recommendation's from the PT consultant. 

If an alternate plan is recommended and treatment is not extended, contact the provider and the worker to explain the reason. Communicate the decision in writing. 

Return to step 5 to monitor the worker's treatment. 

Additional considerations:

When acupuncture is performed alongside physiotherapy, whether by one or two separate practitioners in the same clinic, it is considered part of the physiotherapy service. As a result, the clinic cannot bill for both services separately. 

Note: The fees in the Acupuncture fee guide apply to stand-alone acupuncture treatment only (not when acupuncture is in conjunction with physiotherapy treatment). 

If a worker is wanting to receive physiotherapy care at one clinic and acupuncture at another or physiotherapy and chiropractic care at the same time, this must be reviewed as concurrent care and pre-authorized by the WCB. 

Physiotherapists are not contracted or authorized by the WCB to provide orthotics. If a physiotherapist determines that an orthotic or other appliance is of clinical value to the worker, they will communicate the recommendation to the claim owner with a request to have the worker referred to a WCB-authorized prosthetics and/or orthotics provider to obtain the item. If a claim owner authorizes a physiotherapist to provide the item in error, the payment will be rejected as these items are not within the scope of WCB approval.

Sundry items

Physiotherapists may prescribe sundry items to workers to aid their treatment and recovery of their work-related injury. Pre-authorization is not required from the physiotherapy consultant when the sundry item is listed in the Physiotherapy Fees and Sundry list document and the total cost of all sundry items is less than $250. If a physiotherapist determines that any other item is of clinical value to the worker, they will communicate the recommendation to the claim owner.  

Refer the claim to the physiotherapy consultant for approval when the total cost of all sundry items provided during a treatment episode exceed $250 or the sundry item is not on the list and the cost is over $23. Claim owners are not authorized to approve exceptions.

The following treatments are not funded by the WCB: Sonorex, Decompression therapy (DRS or Vax-D), Pool (Aqua) Therapy and Prolotherapy. Refer to the internal Procedure 40.1E - Medical services not normally authorized for further details. 

Once physiotherapy treatments are authorized, specialized physiotherapy can be delivered by a contracted physiotherapist. Specialized physiotherapy requires additional decision maker approval. Extensions beyond the  maximumhttps://www.wcb.ab.ca/assets/pdfs/providers/PT_sundry_list.pdf allotted visits  requires physiotherapy consultant approval.

Specialized physiotherapy includes:

• vestibular assessmentAn assessment completed by a physiotherapist with specialized training to confirm diagnosis and treatment when a worker presents with symptoms of dizziness.  An assessment completed by a physiotherapist with specialized training to confirm a diagnosis and treatment when a worker presents with symptoms of dizziness.and treatment
• in-home physiotherapy
• one-on-one pool therapy
• post-surgical hand assessment and treatment delivered by a certified hand therapist - Refer to the Hospital physiotherapy and occupational therapy section for the time frames
• internal pelvic floor therapy

A worker may be authorized to receive extended duration visits for a short duration when they meet the criteria: multiple, distinct, compensable injuries to separate body parts 

Once physiotherapy is authorized, providers can invoice for extended duration visits if criteria are met; however, there are set limits on the number of visits before it must be reviewed by a PT Consultant. A claim owner is not authorized to approve extensions of exceptional billing.

All other exceptional billing requests (i.e., treatment frequency exceeds regular parameters) should be forwarded to the PT Consultant for review and pre-approval.

Forward all extension requests beyond the initial set limit to the  PT consultant for review and authorization.

Should the worker request concurrent care, refer the request to the physiotherapy or chiropractic consultant for review and pre-authorization.

Concurrent care is when a worker wishes to receive:

• Both physiotherapy and chiropractic treatment for the same body part/injury at the same time, or
• Physiotherapy or chiropractic treatment at one clinic and acupuncture treatment at another facility.  

In certain instances, concurrent physiotherapy and chiropractic treatments for a compensable injury involving the same body part may be appropriate. 

Physiotherapists and Chiropractors have standards of practice to guide collaborative care.  When collaborative care is provided, it is essential the physiotherapist and chiropractor discuss their treatment plans, goals and ensure the treatments align with the worker's best interests.

Concurrent physiotherapy and chiropractic care should be avoided if the practitioners cannot coordinate their treatments or if there is a risk of duplicating care.

Sometimes, a physiotherapist or chiropractor may decide against treating a worker at the same time as another practitioner. In these instances, regardless of whether it is for the same or a different injury, the decision to start the second treatment is deferred until the first treatment has been completed.

If concurrent treatment is not approved, discuss the decision with the worker to determine which treatment will be authorized.

The community treatment decision is processed in eCO in three ways:

• Auto-entitlement,
• Exception benefit approval task, or
• Decision maker documents the decision (updating the benefit details tab).