Medical and Dental Fee Schedules

The April 1, 2024 Georgia Workers’ Compensation Medical and Dental Fee Schedules are available for purchase from FAIR Health here.

2024 Georgia Workers' Compensation Medical and Dental Fee Schedules

Peer Review for Disputed Medical Charges

For more information or to initiate peer review, please contact: 

Chiropractic Services
Valerie Smith
Executive Director
Georgia Chiropractic Association
1926 Northlake Parkway, Suite 201
Tucker, GA 30084
(770) 723-1100; FAX (770) 723-1722
[email protected]

Physical Therapy Services
Stuart Platt, P.T., M.S.P.T.
Principal
Appropriate Utilization Group, LLC
881 Piedmont Avenue
Atlanta, GA 30309
(404) 728-1974; FAX (404) 728-1975
[email protected]

Notable Rate Changes to the 2024 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). Healthcare Common Procedure Coding System (HCPCS) codes maintained by CMS were updated.
  • CPT and CDT maximum allowable reimbursements (MAR) have been recalculated.  (Note: The 2024 professional maximum allowable reimbursement rate (PROF MAR) for CPT 27278 (arthrodesis sacroiliac joint, percutaneous, with image guidance including placement of intraarticular implants) has been updated to reflect reimbursement for the professional service portion of this code only, as implants are reimbursed separately per the Georgia Medical Fee Schedule guidelines).
  • The inpatient hospital outlier threshold amount was increased from $40,000 to $60,000.
  • The anesthesia conversion factor has been updated to $43.82.
  • Inpatient Medicare severity diagnosis-related group (MS-DRG) codes have been updated to version 41.1, 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 $4.83 for brand name and $7.25 for generic. (See Georgia Workers’ Compensation Medical Fee Schedule for additional guidelines.)
  • Guidelines for Topical Medications added to the General Reimbursement Requirements section:

    Regardless of how many ingredients or what type, topical medications cannot be reimbursed higher than the Category III fee. The 30-day Maximum Fee Schedule value shall be fractioned down to the prescribed and dispensed amount given to the injured worker. Automatic refilling is not allowed. All topical compounds shall be billed and reimbursed using the Georgia fee schedule code corresponding with the applicable category as follows:
    1. Category I GA0801, $80.00 per 30-day supply Any anti-inflammatory medication or any local anesthetic single agent.
    2. Category II GA0802, $160.00 per 30-day supply Any anti-inflammatory agent or agents in combination with any local anesthetic agent or agents.
    3. Category III GA0803, $240.00 per 30-day supply Any agent(s) other than anti-inflammatory or local anesthetic agents, either alone, or in combination with other anti-inflammatory or local anesthetic agents.
  • Home Health Services hourly rates have been updated:

    Registered Nurse (RN)
    $57.71 per hour weekday
    $67.60 per hour weekend and holiday

    Licensed Practical Nurse (LPN)
    $42.87 per hour weekday
    $49.48 per hour weekend and holiday

    Certified Nurse Assistant/Personal Care Attendant (CNA/PCA)
    $28.38 per hour weekday
    $32.44 per hour weekend and holiday

    Non-credentialed Care, Including Family Members
    $11.94 per hour, with a maximum of 12 hours per day

    When care is provided for less than four hours, the allowed rate will be per visit, as indicated below:
    • $148.69 per visit Registered Nurse
    • $121.74 per visit Licensed Practical Nurse
    • $75.79 per visit Certified Nurse Assistant or Personal Care Attendant
    • Physical Therapists, Occupational Therapists and Speech-Language Therapists are reimbursed according to the fee schedule for CPT codes provided in Section X, General Medicine Services, and Section XI, Physical Medicine Services plus $39.79 per visit.

    Note: Domestic services (e.g., lawn mowing services, home cleaning) are not included in this payment system. Please see Section XI, Physical Medicine Services for maximum allowable reimbursement rates for physical and occupational therapy.

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.
  • Physician Testimony/Deposition reimbursement: $600.00 for the first hour and $150.00 for each additional 15 minutes.
  • 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.
  • Medical record copy reimbursement rates:
    Medical record copy charges under a workers’ compensation claim shall be billed at thirty dollars ($30), plus sales tax (if applicable), and actual cost for postage to mail the documents per request. This fee shall cover any request of up to 150 copied pages, and includes any costs associated with research, retrieval, and certification of the records or information requests.

    Any request that exceeds 150 copied pages shall be billed at twenty cents ($0.20) per page, or image if on CD or other electronic storage device that allows electronic retrieval, or copies made from microfilm, and shall include any costs associated with research, retrieval, and certification of the records or information requested. No additional fee beyond the twenty-cent ($0.20) per-page charge shall be billed for requests over 150 pages other than actual cost for postage to mail the documents per request and sales tax (if applicable).

    Providers who use a medical record company to make and provide copies of medical records must ensure that reimbursement requirements are followed in accordance with the above fee schedule guidelines. Radiograph copies, either by film, CD, or digital, shall be reimbursed at $9.50 per image, not to exceed a maximum of $30.00.

    A maximum allowable fee of $5.00 may be charged only if a medical record search results in no medical records found as requested. However, documentation (such as a computer screen printout or certification that no record(s) have been found) identifying specifically that no records were found for that request must be provided with the bill. No other charges shall be reimbursable beyond this medical record copy fee schedule.
  • Supplies, DME, prosthetics and orthotics, and rental equipment reimbursement:
    Medical supplies (e.g., sterile trays) provided by the physician or other medical provider over and above those usually included with the office visit (e.g., Band-Aids and cotton swabs) or other services rendered may be listed separately using CPT code 99070. Medical supplies and durable medical equipment are reimbursed at cost times 1.5 plus $4.00 for handling fee charges. Charges greater than $50.00 must be accompanied by a copy of the wholesale vendor invoice(s) showing the actual cost of the item. Certain procedures include supplies; therefore, CPT code 99070 would not be reported. Custom-made orthotics/prosthetics and rental equipment are exempt from the supplies and equipment reimbursement formula; however, usual, customary, and reasonable charges will apply.