Medical and Dental Fee Schedules
The April 1, 2019 Georgia Workers’ Compensation Medical and Dental Fee Schedules are available for purchase from FAIR Health here.
Amendments and notable information to the April 1, 2019 fee schedule will be posted here on this link.
Additional information and notable changes to the 2019 fee schedules are as follows:
CPT and CDT maximum allowable reimbursements (MAR) have been recalculated.
- 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.
- 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).
- Functional Capacity Evaluations (FCE01) – not to exceed $800.00.
- Holidays defined for holiday reimbursement rates.
- Explanation of Benefits requirements.
- 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.
- Physician Testimony/Deposition reimbursement; $600.00 for the first hour and $150.00 for each additional 15 minutes.
- Ambulance and Air Services transportation reimbursement rates.
- Non-Emergency transportation reimbursement rates.
- Anesthesia conversion factor is $39.46.
- Home Health Services reimbursement rates.
- Medical record copy reimbursement.
- 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.
- 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.