A State Medical Fee Schedule Usually Saves Funds
States without a Workers Compensation medical fee schedule become more rare every year.
At last count, there are approximately 42 states with fee schedules. They basically allow a maximum charge for a medical provider (physician, hospital, physical therapist, etc.) per CPT code. The CPT codes became much more complicated with the ICD 10 code arrival.
The medical provider can charge much more than the fee schedule. The charge will be cut to the schedule unless there are extenuating circumstances.
In some states, a BR or by report is added to the CPT code to let the insurance carrier and the Industrial Commission know that their bill needs to be reviewed individually and not just cut to fee schedule. I often see BR CPT codes coming from university-based medical providers such as Duke University Medical Systems.
The BR does not denote a medical provider overcharging for their services. The medical provider feels the fee schedule amount of the CPT codes does not represent the fees charged if the carrier/TPA uses the standard schedule.
Update – the ICD10 codes have been released in 2013. These codes may end up changing some of the workers comp procedure codes in the very near future.
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