The May 1, 2014, Georgia Workers’ Compensation Medical Fee Schedule is available for purchase. Click on the link(s) below which will direct you to the website where you can place your order.
Any updates to this year’s fee schedule will be posted here from a link on the bottom of this page.
Some notable changes to the 2014 fee schedule are as follows:
- Maximum allowable reimbursements (MAR) have been recalculated for all sections including Physician, Home Health Services, Transportation, and Inpatient Hospital.
- Outpatient Services – Hospital/ASC Section – ICD-9 coding methodology has been removed in preparation of the implementation of ICD-10 in the future. This section has been modified adopting the Medicare OPPS reimbursement model, with state-specific guidelines, as the new billing and payment methodology.
In addition, Ambulatory surgery centers are required to be Medicare certified effective August 1, 2013
- Current procedural terminology (CPT) codes were updated with code additions, deletions and revisions in accordance with the American Medical Association (AMA).
- Inpatient Medicare severity diagnosis-related group (MS-DRG) codes have been updated to Version 31.0.
- Two new Board-approved peer review entities added – Dane Street and Examworks.
- List of acronyms defined (see Section IV).
- Functional Capacity Evaluations (FCE01) – not to exceed $800.00 (unchanged from April 2013).
- Holiday days defined for holiday reimbursement rates.
- Explanation of Benefits requirements (unchanged from April 2013).
- Independent medical evaluation (IME) rates remain unchanged from April 2013 reimbursement; $600.00 for the first hour and $150.00 for each additional 15 minutes. For a no-show of an IME, reimbursement shall be at $150.00. Use state-specific code IME01 when billing for IMEs.
- Physician Testimony/Deposition reimbursement remains unchanged; $600.00 for the first hour and $150.00 for each additional 15 minutes.
- Transportation – Ambulance and Air Services reimbursement rates have been recalculated.
- Non-Emergency Transportation reimbursement rates have been recalculated.
- Anesthesia conversion factor is $38.57.
- Home Health Services hourly rates have been recalculated.
- Medical record copy reimbursement (unchanged from April 2013).
- Pharmaceuticals – compound drug and over-the-counter medication guidelines have been added to the May 1, 2014 fee schedule (see Section IV).
Both brand name and generic pharmaceuticals are reimbursed at the average wholesale price (AWP) in the Medi-Span Directory as in past fee schedules.
- Supplies, DME, prosthetics and orthotics, and rental equipment reimbursement is unchanged from April 2013.
- Electronic Billing and Payment National Companion Guide and Georgia e-Bill Rule Review
- The most current CMS 1500 billing form, version 2/12, is adopted by this fee schedule, with a grace period to be determined.