Medical and Dental Fee Schedules

The April 1, 2018 Georgia Workers’ Compensation Medical and Dental Fee Schedules are available for purchase from FAIR Health here.     

Amendments to the April 1, 2018 fee schedule will be posted here on this link.

Additional information and notable changes to the 2018 fee schedules are as follows:

  1. ICD-10-CM/PCS diagnosis and procedure coding has been adopted by the State Board of Workers’ Compensation to coincide with the Centers for Medicare and Medicaid Services’ (CMS) implementation date of October 1, 2015. 

  2. CPT and CDT maximum allowable reimbursements (MAR) have been recalculated.
  3. Outpatient Services – Hospital/ASC Section: The Medicare outpatient prospective payment system (OPPS) reimbursement model, with state-specific guidelines, remains as the billing and payment methodology.

    Ambulatory surgery centers are required to be Medicare certified effective August 1, 2013.
  4. Current procedural terminology (CPT) and Current Dental Terminology (CDT) codes were updated with code additions, deletions and revisions in accordance with the American Medical Association (AMA) and the American Dental Association (ADA).
  5. Inpatient Medicare severity diagnosis-related group (MS-DRG) codes have been updated to version 35 with a base rate increase.
  6. Functional Capacity Evaluations (FCE01) – not to exceed $800.00.
  7. Holidays defined for holiday reimbursement rates.
  8. Explanation of Benefits requirements.
  9. Independent medical examination (IME) – new state-specific codes have been added as follows:
    IME00 – completed examination, no prior prepayment
    IME01 – prepayment of first 2 hours (Board Rule 202(b))
    IME02 – subsequent hour(s) beyond the 2-hour prepayment
    IME03 – no show fee ($150.00)

    Reimbursement rates remain unchanged; $600.00 for the first hour or parts thereof and $150.00 for each additional 15 minutes.
  10. Physician Testimony/Deposition reimbursement; $600.00 for the first hour and $150.00 for each additional 15 minutes.
  11. Ambulance and Air Services transportation reimbursement rates.
  12. Non-Emergency transportation reimbursement rates.
  13. Anesthesia conversion factor is $39.46.
  14. Home Health Services hourly rates have changed.
  15. Medical record copy reimbursement.
  16. Pharmaceutical – both brand name and generic pharmaceuticals are reimbursed at the average wholesale price (AWP) in the Medi-Span Directory.  Dispensing fees are $4.36 brand name and $6.53 generic.

    Compound drug and over-the-counter medication guidelines have been added to the May 1, 2014 fee schedule (see Section IV).
  17. Supplies, DME, prosthetics and orthotics, and rental equipment reimbursement.
  18. Electronic Billing and Payment National Companion Guide and Georgia e-Bill Rule Review.
  19. The most current CMS 1500 billing form, version 2/12, is adopted in the medical fee schedule, and the ADA Dental Claim Form © 2012 has been adopted in the dental fee schedule.