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Understanding DWC medical reimbursement policies and fee guideline rules is crucial to successful reimbursement for workers' compensation claims. For more information, contact us at 800-252-7031, option 3 or CompConnection@tdi.texas.gov.
The Medical Fee Guideline conversion factors are established by 28 Texas Administrative Code §134.203. Under Labor Code §413.011(a), fee guidelines adopted by the Division of Workers’ Compensation (DWC) for non-network services and approved out-of-network services are based on the most current reimbursement methodologies, models, and values ...
This rate guide is published to assist you in comparison shopping for your workers' compensation coverage. A company may choose to base its rates on its own independent company-specific relativities filed by the company or loss costs filed by the National Council on Compensation Insurance (NCCI), an advisory organization to the Texas Department ...
This section provides information about state-mandated medical fee schedules and/or guidelines for services rendered to injured workers. Note the following: . For those states where a medical fee schedule or other reimbursement guideline has been adopted, a link is provided (copy and paste into web browser) .
Medical Fee Guideline for Workers' Compensation Specific Services Latest version. (a) Specific provisions contained in the Labor Code or division rules, including this chapter, shall take precedence over any conflicting provision adopted or utilized by the Centers for Medicare and Medicaid Services (CMS) in administering the Medicare program.
TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION. CHAPTER 134. BENEFITS--GUIDELINES FOR MEDICAL SERVICES, CHARGES, AND PAYMENTS. Subchapters.
TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION. CHAPTER 134. BENEFITS--GUIDELINES FOR MEDICAL SERVICES, CHARGES, AND PAYMENTS. SUBCHAPTER A.
Pathology/laboratory codes have technical and professional components. When using the Medicare Clinical Laboratory Fee Schedule, reimbursement amounts are as follows: Technical component = 125% of Medicare Clinical Laboratory Fee Schedule amount. Professional component = 45% of MAR for the technical component.
(1) This section applies to professional medical services provided in the Texas workers' compensation system, other than: (A) workers' compensation specific codes, services, and programs described in §134.204 of this title (relating to Medical Fee Guideline for Workers' Compensation Specific Services);
The OWCP fee schedule Effective June 30, 2021 is being offered in view and download format. There are eleven files, altogether: seven files are in Microsoft® EXCEL; and four files are in Microsoft® WORD.