Title 803 | Chapter 025 | Regulation 089
PREVIOUS VERSION
The previous document that this document is based upon is available.
803 KAR 25:089.Workers' compensation 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.HISTORY: (21 Ky.R. 1603; eff. 2-9-1995; 23 Ky.R. 1750; 2485; eff. 12-12-1996; 25 Ky.R. 915; 1362; eff. 11-18-1998; 28 Ky.R. 1226; eff. 1-14-2002; 32 Ky.R. 747; eff. 1-6-2006; 35 Ky.R. 404, eff. 12-5-2008; 37 Ky.R. 1078 1492; eff. 3-4-2011; 40 Ky.R. 1907; 2304; eff. 6-6-2014; 43 Ky.R. 28, 404; eff. 10-7-2016; 45 Ky.R. 158, 1193; eff. 12-7-2018; 47 Ky.R. 382, 1217; eff. 3-2-2021; 49 Ky.R. 440, 1263; eff. 3-7-2023.)
FILED WITH LRC: November 9, 2022
CONTACT PERSON: B. Dale Hamblin, Jr., Assistant General Counsel, Workers’ Claims Legal Division, Mayo-Underwood Building, 3rd Floor, 500 Mero Street, Frankfort, Kentucky 40601, phone (502) 782-4404, fax (502) 564-0682, email dale.hamblin@ky.gov.
803 KAR 25:089.Workers' compensation 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(2)
Procedures Listed Without Specified Maximum Allowable Reimbursement Monetary Amount.(3)
The resulting fee shall not be more thanSection 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(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(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.HISTORY: (21 Ky.R. 1603; eff. 2-9-1995; 23 Ky.R. 1750; 2485; eff. 12-12-1996; 25 Ky.R. 915; 1362; eff. 11-18-1998; 28 Ky.R. 1226; eff. 1-14-2002; 32 Ky.R. 747; eff. 1-6-2006; 35 Ky.R. 404, eff. 12-5-2008; 37 Ky.R. 1078 1492; eff. 3-4-2011; 40 Ky.R. 1907; 2304; eff. 6-6-2014; 43 Ky.R. 28, 404; eff. 10-7-2016; 45 Ky.R. 158, 1193; eff. 12-7-2018; 47 Ky.R. 382, 1217; eff. 3-2-2021; 49 Ky.R. 440, 1263; eff. 3-7-2023.)
FILED WITH LRC: November 9, 2022
CONTACT PERSON: B. Dale Hamblin, Jr., Assistant General Counsel, Workers’ Claims Legal Division, Mayo-Underwood Building, 3rd Floor, 500 Mero Street, Frankfort, Kentucky 40601, phone (502) 782-4404, fax (502) 564-0682, email dale.hamblin@ky.gov.