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The April 1, 2013, 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. 

Be sure to check this website for any updates to each year’s fee schedule as they will be posted here.

Some notable changes to the 2013 fee schedule are as follows:

  1. Maximum allowable reimbursements (MAR) have been recalculated for physician and inpatient sections.  Outpatient remains unchanged from April 2011.
  2. Current procedural terminology (CPT) codes were updated with code additions, deletions and revisions in accordance with the American Medical Association (AMA).
  3. Inpatient Medicare severity diagnosis-related group (MS-DRG) codes have been updated to Version 30.0.
  4. Ambulatory surgery centers required to be Medicare certified by August 1, 2013 (see Amendment of May 6, 2013).
  5. Functional Capacity Evaluations (FCE01) – not to exceed $800.00.
  6. Holiday days defined for holiday reimbursement rates.
  7. Explanation of Benefits requirements.
  8. Independent medical evaluation (IME) rates remain unchanged from April 1, 2011 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.
  9. Physician Testimony/Deposition reimbursement remains unchanged; $600.00 for the first hour and $150.00 for each additional 15 minutes.
  10. Transportation – Ambulance and Air Services reimbursement rates have been recalculated. 
  11. Non-Emergency Transportation reimbursement rates have been recalculated.
  12. Anesthesia conversion factor is $37.93.
  13. Home Health Services hourly rates have been recalculated. 
  14. Medical record copy reimbursement.
  15. Pharmaceuticals – both brand name and generic pharmaceuticals are reimbursed at the average wholesale price (AWP) in the Medi-Span Directory.
  16. Supplies, DME, prosthetics and orthotics, and rental equipment reimbursement is unchanged from April 2012.
  17. Electronic Billing and Payment National Companion Guide and Georgia e-Bill Rule Review

April 1, 2013 Medical Fee Schedule - Binder & CD
Previous fee schedules can be purchased by calling Ingenix at 1-800-464-3649.