This filing was published in the 05/15/2008, issue, Vol. 2008, No. 10, of the Utah State Bulletin.
Labor Commission, Industrial Accidents
Regulation of Medical Practitioner Fees
NOTICE OF PROPOSED RULE
DAR File No.: 31333
Filed: 04/30/2008, 01:15
Received by: NL
Purpose of the rule or reason for the change:
The purpose of this amendment is to adopt, with modifications, the 2008 Resource-Based Relative Value Schedule (RBRVS) and the 2008 American Medical Association Current Procedural Terminology (CPT) coding standards.
Summary of the rule or change:
The proposed amendment updates the existing rule by incorporating the 2008 versions of the RBRVS and CPT. The amendment also assigns a relative value of $46 for the evaluation and management of medical care provided to injured workers.
State statutory or constitutional authorization for this rule:
Sections 34A-2-101 et seq., 34A-3-101 et seq., and 34A-1-104
This rule or change incorporates by reference the following material:
National Centers for Medicare and Medicaid Service (CMS) for the Medicare Physician Fee Schedule (MPF)"Resource-Based Relative Value Scale" (RBRVS) 2008 edition; and the American Medical Association's CPT, 2008 edition coding guidelines
Anticipated cost or savings to:
the state budget:
The proposed amendment will impose no additional administrative or enforcement costs on the state budget. The minimal increase in workers' compensation medical expense that will result from this amendment is unlikely to affect workers' compensation premiums. Consequently, the amendment will not result in any measurable increase in the state's cost of workers' compensation insurance.
The minimal increase in workers' compensation medical expense that will result from this amendment is unlikely to affect workers' compensation premiums. Consequently, the amendment will not result in any measurable increase in local governments' cost of workers' compensation insurance.
small businesses and persons other than businesses:
The minimal increase in workers' compensation medical expense that will result from this amendment is unlikely to affect workers' compensation premiums. Consequently, the amendment will not result in any measurable increase in the cost of workers' compensation insurance for small businesses or other persons.
Compliance costs for affected persons:
Currently workers' compensation benefits cost Utah employers and insurance carriers approximately $200,000,000 per year. The proposed amendment will increase these costs by $225,000 or approximately one-tenth of one percent.
Comments by the department head on the fiscal impact the rule may have on businesses:
The minimal increase to workers' compensation medical costs provided by this rule are relatively insignificant and unlikely to have any fiscal impact on the businesses subject to the rule. Sherrie Hayashi, Commissioner
The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:Labor Commission
HEBER M WELLS BLDG
160 E 300 S
SALT LAKE CITY UT 84111-2316
Direct questions regarding this rule to:
Larry Bunkall at the above address, by phone at 801-530-6988, by FAX at 801-530-6844, or by Internet E-mail at email@example.com
Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:
This rule may become effective on:
Sherrie Hayashi, Commissioner
R612. Labor Commission, Industrial Accidents.
R612-2. Workers' Compensation Rules-Health Care Providers.
R612-2-5. Regulation of Medical Practitioner Fees.
Pursuant to Section 34A-2-407:
A. The Labor Commission of Utah:
1. Establishes and regulates fees and other charges for medical, surgical, nursing, physical and occupational therapy, mental health, chiropractic, naturopathic, and osteopathic services, or any other area of the healing arts as required for the treatment of a work-related injury or illness.
2. Adopts and by
this reference incorporates the National Centers for Medicare and Medicaid
Services (CMS) for the Medicare Physician Fee Schedule (MPFS)
"Resource-Based Relative Value Scale" (RBRVS), 200[
edition, as the method for calculating reimbursement and the American Medical
Association's CPT-4, 200[ 7] edition, coding guidelines. The non-facility total unit value will apply
in calculating the reimbursement, except that procedures provided in a facility
setting shall be reimbursed at the facility total unit value and the facility
may bill a separate facility charge.
The CPT-4 coding guidelines and RBRVS are subject to the Utah Labor
Commission's Medical Fee Guidelines and Codes and the following Labor
Commission conversion factors for medical care rendered for a work-related
injury or illness, effective July 1[ 1], 200[ 7]:
(Conversion Rates below EFFECTIVE July 1[ 1], 200[ 7], to
be used with the RBRVS procedural Unit value as per specialty.)
Anesthesiology $41.00 (1 unit per 15 minutes of anesthesia);
Medicine E and
M $44.00; Codes 99201-99204
and 99211-99214 $45]
150% of Utah's published Medicare carrier];
4].00, with Utah code 97001 and 97003 at a 1.5
relative value unit and Utah code 97002 and 97004 at a 1.0 of relative value
All 20000 codes, codes 49505 thru 49525 and all 60000 codes of the CPT-4 coding guidelines $58.00.
3. Adopts and
incorporates by this reference the Utah Labor Commission's Medical Fee
Guidelines and Codes, as of July 1[
1], 200[ 7]. The Utah Medical Fee Guidelines and Codes
can be obtained from the division for a fee sufficient to recover costs of
development, printing, and mailing or can be downloaded at the Labor
Commission's website at [ www.laborcommission.utah.gov/indacc/indacc.htm].
4. Decides appropriate billing procedure codes when disputes arise between the medical practitioner and the employer or its insurance carrier. In no instance will the medical practitioner bill both the employer and the insurance carrier.
B. Employees cannot be billed for treatment of their work-related injuries or illnesses.
C. Discounting from the fees established by the Labor Commission is allowed only through specific contracts between a medical provider and a payor for treatment of work-related injury or illness.
D. Restocking fee 15%. Rule R612-2-16 covers the restocking fee.
E. Dental fees are not published. Rule R612-2-18 covers dental injuries.
F. Ambulance fees are not published. Rule R612-2-19 covers ambulance charges.
KEY: workers' compensation, fees, medical practitioner
Date of Enactment or Last Substantive
October 9, 2007]
Notice of Continuation: May 28, 2003
Authorizing, and Implemented or Interpreted Law: 34A-2-101 et seq.; 34A-3-101 et seq.; 34A-1-104
Text to be deleted is struck through and surrounded by brackets (e.g., [
example]). Text to be added is underlined (e.g., ). Older browsers may not depict some or any of these attributes on the screen or when the document is printed.
For questions regarding the content or application of this rule, please contact Larry Bunkall at the above address, by phone at 801-530-6988, by FAX at 801-530-6844, or by Internet E-mail at firstname.lastname@example.org
For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764). Please Note: The Division of Administrative Rules is NOT able to answer questions about the content or application of these administrative rules.
Last modified: 05/14/2008 3:03 PM