Current through Register Vol. 51, No. 3, September 1, 2024
RELATES TO:
KRS
342.0011(32),
342.019,
342.020,
342.035
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
342.035(1) requires the
commissioner of the Department of Workers' Claims to promulgate administrative
regulations to ensure that all fees, charges, and reimbursements for medical
services under KRS Chapter 342 are limited to charges that are fair, current,
and reasonable for similar treatment of injured persons in the same community
for like services, where treatment is paid for by general health insurers.
KRS
342.035(4) requires the
commissioner to promulgate an administrative regulation establishing the
workers' compensation medical fee schedule for physicians.
KRS
342.035 requires a schedule of fees to be
reviewed and updated, if appropriate, every two (2) years on July 1. This
administrative regulation establishes the medical fee schedule for
physicians.
Section 1. Definitions.
(1) "Medical fee schedule" means the 2022
Kentucky Workers' Compensation Schedule of Fees for Physicians.
(2) "Physician" is defined by
KRS
342.0011(32).
Section 2. Services Covered.
(1) The medical fee schedule shall govern all
medical services provided to injured employees by physicians under KRS Chapter
342.
(2) The medical fee schedule
shall also apply to other health care or medical services providers to whom a
listed CPT code is applicable unless:
(a)
Another fee schedule of the Department of Workers' Claims applies;
(b) A lower fee is required by
KRS
342.035 or a managed care plan approved by
the commissioner pursuant to
803 KAR 25:110; or
(c) An insurance carrier, self-insured group,
or self-insured employer has an agreement with a physician, medical bill
vendor, or other medical provider to provide reimbursement of a medical bill at
an amount lower than the medical fee schedule.
Section 3. Fee Computation.
(1) The appropriate fee for a procedure or
item covered by the medical fee schedule shall be the Maximum Allowable
Reimbursement (MAR) listed in the 2022 Kentucky Workers' Compensation Schedule
of Fees for Physicians for those procedures or items for which a specific
monetary amount is listed.
(2)
Procedures Listed Without Specified Maximum Allowable Reimbursement Monetary
Amount. The appropriate fee for a procedure or item for which a specific
monetary amount is not listed shall be determined and calculated in accordance
with numerical paragraph six (6) of the General Instructions of the medical fee
schedule unless more specific Ground Rules are applicable to that service or
item, in which case the fee shall be calculated in accordance with the
applicable Ground Rules.
(3) The
resulting fee shall not be more than the maximum fee allowed for the service
provided.
Section 4.
(1) A physician or healthcare or medical
services provider located outside the boundaries of Kentucky shall be deemed to
have agreed to comply with this administrative regulation if it treats a
patient who is covered under KRS Chapter 342.
(2) Pursuant to
KRS
342.035, medical fees due to an out-of-state
physician or healthcare or medical services provider shall be calculated under
the fee schedule in the same manner as for an in-state physician.
Section 5. Incorporation by
Reference.
(1) "2022 Kentucky Workers'
Compensation Schedule of Fees for Physicians", July 1, 2022 Edition, is
incorporated by reference.
(2) This
material may be inspected, copied, or obtained, subject to applicable copyright
law, at the Department of Workers' Claims, Mayo-Underwood Building 3rd Floor,
500 Mero Street, Frankfort, Kentucky 40601, Monday through Friday, 8 a.m. to
4:30 p.m.
(3) This material may
also be obtained from or through
https://labor.ky.gov/comp/Pages/Medical-Services.aspx#
Physican Fee Schedule.
STATUTORY AUTHORITY:
KRS
342.020,
342.035(1),
(4)
