Medical and Dental Fee Schedules
The April 1, 2020 Georgia Workers’ Compensation Medical and Dental Fee Schedules are available for purchase from FAIR Health here.
Notable changes to the 2020 Medical and Dental Fee Schedules:
- 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).
- CPT and CDT maximum allowable reimbursements (MAR) have been recalculated.
- Certain services noted with a star icon are eligible to be provided via telemedicine. The MAR for services provided via telemedicine is the same as for services provided in an office or facility.
- Home Health Services hourly rates have been updated.
- Ambulance and Air Services transportation reimbursement rates have been updated.
- Non-Emergency transportation reimbursement rates have been updated.
- Anesthesia conversion factor has been updated to $40.05.
- Inpatient Medicare severity diagnosis-related group (MS-DRG) codes have been updated to version 35 with a base rate increase.
- Pharmaceutical – both brand name and generic pharmaceuticals are reimbursed at the average wholesale price (AWP) in the Medi-Span Directory. Dispensing fees have been updated to $4.43 for brand name and $6.63 for generic.
Additional Medical Fee Schedule Information:
- 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.
- 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.
- Functional Capacity Evaluations (FCE01) – not to exceed $800.00.
- Holidays defined for holiday reimbursement rates.
- Explanation of Benefits requirements.
- Physician Testimony/Deposition reimbursement; $600.00 for the first hour and $150.00 for each additional 15 minutes.
- Medical record copy reimbursement rates.
- Supplies, DME, prosthetics and orthotics, and rental equipment reimbursement.
- 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 in the Medical Fee Schedule, and the ADA Dental Claim Form © 2012 has been adopted in the Dental Fee Schedule.