Wyoming Administrative Code
Agency 053 - Workforce Services, Department of
Sub-Agency 0021 - Workers' Compensation Division
Chapter 9 - FEE SCHEDULES
Section 9-2 - Fee Schedules

Universal Citation: WY Code of Rules 9-2

Current through September 21, 2024

(a) The Division adopts the most recent version published prior to the date of service for the following references Geographically Adjusted Resource Based Relative Value Scale (RBRVS), as published by Optum 360, LLC, as authored by the American Medical Association (AMA), insofar as it addresses medical matters under the Act unless otherwise defined in this chapter and, the Relative Values for Dentists (RVD), as published and authored by Relative Value Studies, Inc., Thornton, Colorado, insofar as it addresses dental matters under the Act.

(i) The Division has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules;

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (a) of this section; and

(iii) The incorporated code, standard, rule or regulation is maintained at 5221 Yellow stone Road, Cheyenne, WY 82002 and is available for public inspection and copying at cost at the same location.

(b) Each code incorporated by reference in these rules is further identified as follows:

(i) RBRVS, including gap fill code values and RVD, as they were in effect on the date of service submitted, and adopted by the Department of Workforce Services, Wyoming Workers' Compensation Division.

(ii) National Correct Coding Initiative (NCCI) as they were in effect on January 1, of the year for the date of service submitted, and adopted by the Department of Workforce Services, Wyoming Workers' Compensation Division found at: https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd.

(c) There are six (6) conversion factors (CF) for the Professional Fee Schedule, Wyoming uses the National RBRVS system and recognizes the below conversion factors:

SPECIALTY GROUP CONVERSION FACTOR
Anesthesia $ 53.38
Spine Procedures $ 77.49
Evaluation and Management $ 37.84
Physical Med/Radiology/Surgery $ 66.67
Radiology- MRI Services Only $ 106.74
Dental $ 55.73

(d) Modifiers for Anesthesia and Surgical Assistants.

(i) Surgical Assistants.
(A) MD assistants shall be paid 20% of the surgical allowance.

(B) Non-MD assistants shall be paid 15% of the surgical allowance.

(ii) Anesthesia.
(A) All services are paid in accordance with the Wyoming Fee Schedules in effect at the time that services are rendered.

(B) At least one of the following anesthesia modifiers must be submitted with each bill.

(C) Modifiers P1-P6 are suggested but not required.

(D) AA-anesthesia services performed by the Anesthesiologist, are paid at one hundred percent (100%) of the allowable fees.

(E) AD-medical supervision by a Physician with more than four (4) concurrent anesthesia procedures are paid at fifty percent (50%) of the allowable fees.

(F) QK-medical direction of two (2), three (3) or four (4) concurrent anesthesia procedures involving qualified individuals are paid at fifty percent (50%) of the allowable fees.

(G) QX-qualified non-physician anesthetists with medical direction by a Physician are paid at fifty percent (50%) of the allowable fees.

(H) QY-medical direction of one qualified non-physician Anesthetist by an Anesthesiologist are paid at fifty percent (50%) of the allowable fees.

(I) QZ-CRNA (Certified Registered Nurse Anesthetist) without medical direction by a Physician are paid at one hundred percent (100%) of the allowable fees.

(e) Fees for Independent Medical Evaluations (IME), Permanent Partial Impairment Ratings (PPI), Medical Testimony and Deposition(s). See Chapter 10, and Chapter 9, Section 1 for additional guidelines. Medical bills must indicate total time spent on review of records, actual examination and writing of the report on the written report and the CMS-1500 claim form. The medical report must include a breakdown of the total time spent. Medical bills must also include time spent on travel, if applicable.

(i) Independent Medical Evaluations (IME) or Impairment Ratings. The Division shall pay according to the following fee schedule:
(A) If the IME or Impairment Rating is completed by the treating physician, use Code 99455. If the IME or Impairment Rating is completed by a physician, other than the treating healthcare provider, use Code 99456.

CodeTimePayment
99455-99456 1st hour $750.00
Each additional 15 minutes $93.75

(B) Fees for No Call/No Show appointments, where a paper file review with report is submitted to the Division will be paid in accordance with the above fee schedule.

(C) Fees for No Call/No Show appointments, where a paper file review with report is not completed or submitted to the Division must be billed to the claimant.

(ii) Medical Testimony and Deposition Charges. The Division shall pay according to the following fee schedule:

CodeTimePayment
99075 1st hour $750.00
Each additional 15 minutes $65.00

Disclaimer: These regulations may not be the most recent version. Wyoming may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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