Medical Fee Schedule

The April 1, 2016 Georgia Workers’ Compensation Medical Fee Schedule is available for purchase from FAIR Health here.     

Any amendments to this year’s fee schedule will be posted here on this link.

Additional information and notable changes to the 2016 fee schedule are as follows:

  1. The State Board of Workers’ Compensation has adopted ICD-10-CM/PCS for diagnosis and procedure coding to coincide with the Centers for Medicare and Medicaid Services’ (CMS) implementation date of October 1, 2015. 
  1. CPT maximum allowable reimbursements (MAR) have been recalculated.
  1. 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.
  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 32.0.
  1. Functional Capacity Evaluations (FCE01) – not to exceed $800.00.
  1. Holiday days defined for holiday reimbursement rates.
  1. Explanation of Benefits requirements.
  1. Beginning April 1, 2016, there have been two additional state-specific codes added when billing for an independent medical evaluation (IME).
    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 minute.
  2. Physician Testimony/Deposition reimbursement; $600.00 for the first hour and $150.00 for each additional 15 minutes.
  3. Ambulance and Air Services transportation reimbursement rates.
  1. Non-Emergency transportation reimbursement rates.
  1. Anesthesia conversion factor is $38.99.
  1. Home Health Services hourly rates have changed.
  1. Medical record copy reimbursement.
  1. Pharmaceutical – both brand name and generic pharmaceuticals are reimbursed at the average wholesale price (AWP) in the Medi-Span Directory.  Dispensing fees have changed to $4.31 brand name and $6.45 generic.

Compound drug and over-the-counter medication guidelines have been added to the May 1, 2014 fee schedule (see Section IV).

  1. Supplies, DME, prosthetics and orthotics, and rental equipment reimbursement.
  1. Electronic Billing and Payment National Companion Guide and Georgia e-Bill Rule Review.
  1. The most current CMS 1500 billing form, version 2/12, is adopted by this fee schedule.