April 19, 2011

Recent Changes in the Georgia Workers' Compensation Medical Fee Schedule

by Chuck DuBose, Esq.

As of April 1, 2011 the State Board of Workers' Compensation made changes in the Medical Fee Schedule. Notable changes include the following:

1. Maximum allowable reimbursements (MAR) have all been recalculated.

2. CPT codes were updated with code additions, deletions and revisions in accordance with the AMA.

3. Ambulance and Air Service transportation reimbursement rates have increased. (see schedule for Ambulance and Air Service Transportation: http://www.davidandrosetti.com/newsletter/april11/2011%20Fee%20Schedule%20Ambulance%20and%20Air%20transportation.pdf)

4. Non-Emergency Transportation reimbursements have increased. (see schedule for Non-Emergency Transportation: http://www.davidandrosetti.com/newsletter/april11/2011%20Fee%20Schedule%20Non-Emergency%20transportation.pdf)

5. Anesthesia base rate has been increased to $36.56.

6. Home Health Services hourly rates have increased. (see schedule for Home Health Services: http://www.davidandrosetti.com/newsletter/april11/2011%20Fee%20Schedule%20Home%20Health%20Services.pdf)

7. Medical Record copy reimbursement. The minimum charge has increased from $25 to $30 for a request for medical records, plus sales tax and postage (for up to 150 pages), with a $0.20 per page charge for any request that is for more than 150 pages. (see medical record reimbursement requirements: http://www.davidandrosetti.com/newsletter/april11/2011%20Fee%20Schedule%20Medical%20Record.pdf)

8. Pharmaceuticals – See IMPORTANT UPDATE concerning generic prescription drugs versus brand-name prescription drugs and concerning reimbursement for prescription drugs: http://www.davidandrosetti.com/newsletter/april11/2011%20Fee%20Schedule%20Pharmaceuticals.pdf

9. Supplies, DME, prosthetics and orthotics, and rental equipment reimbursement is unchanged from 2010. (see schedule for medical supplies: http://www.davidandrosetti.com/newsletter/april11/2011%20Fee%20Schedule%20Medical%20Supplies.pdf)

The Independent Medical Evaluation ( IME) rates remain unchanged from April 1, 2010; $600.00 for the first hour and $150.00 for each additional 15 minutes. For a no-show at an IME, reimbursement shall be at $150.00. Use state-specific code IME01 when billing for IME.

Also, Physician Testimony/Deposition reimbursement remains unchanged from April 1, 2010; $600.00 for the first hour and $150.00 for each additional 15 minutes.

If you have questions or comments, please reply to this post or contact your David & Rosetti attorney at 404-446-4488 or by visiting our website at www.davidandrosetti.com.

Nothing contained in this blog should be construed as legal advice or opinion on specific facts. For editorial comments or suggestions, please contact David W. Willis at (404) 446-4491 or david.willis@davidandrosetti.com.

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