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Where Do I Find Workers Compensation State Medical Fee Schedule?

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A State Medical Fee Schedule Usually Saves Funds

States without  a Workers Compensation medical fee schedule become more rare every year.

Picture of Doctor Writing Fee Schedule of Patient
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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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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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