Title 120 | Chapter 001 | Regulation 089REG
PROPOSED
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PREVIOUS VERSION
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OFFICE OF THE GOVERNOR
Department of Workers’ Claims
(Amended at ARRS Committee)
120 KAR 1:089.Workers' compensation medical fee schedule for physicians.
Section 1.
Definitions.(1)
"Medical fee schedule" means the 2026(2)
Section 2.
Purpose and Adoption.(1)
The purpose of the schedule of fees shall be(2)
TheSection 3.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, HCPCS, or Transportation 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 120 KAR 001:110(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 4.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 2026(2)
Procedures Listed Without Specified Maximum Allowable Reimbursement Monetary Amount. The appropriate fee for a procedure or item for which a(3)
The resulting fee shall be the maximum fee allowed for the service provided.Section 5.Section 4.
Services Performed Outside the Boundaries of Kentucky.(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.
(1)
(2)
(3)
FILED WITH LRC: October 13, 2026
CONTACT PERSON: B. Dale Hamblin, Jr., Assistant General Counsel, Department of Workers’ Claims. Mayo-Underwood Building, 3rd Floor 500 Mero Street, Frankfort, Kentucky 40601. Telephone Number: (502) 782-4404, Fax Number: (502) 564-0681 Email: Dale.Hamblin@ky.gov
OFFICE OF THE GOVERNOR
Department of Workers’ Claims
(Amended at ARRS Committee)
120 KAR 1:089.Workers' compensation medical fee schedule for physicians.
Section 1.
Definitions.(1)
"Medical fee schedule" means the 2026 Kentucky Workers' Compensation Schedule of Fees for Physicians produced and published by FAIR Health, Inc.(2)
"Physician" is defined by KRS 342.0011(32).Section 2.
Purpose and Adoption.(1)
The purpose of the schedule of fees shall be to regulate charges by medical providers and other health care professionals providing services for work-related injuries and occupational diseases. The commissioner shall review and update the schedule of fees every two (2) years as required by KRS 342.035.(2)
The 2026 Kentucky Workers' Compensation Schedule of Fees for Physicians, produced and published by FAIR Health, Inc. may be obtained directly from FAIR Health, Inc., at https://orders.fairhealth.org/.Section 3.
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, HCPCS, or Transportation 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 120 KAR 001:110; 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 4.
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 2026 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 seven (7) of the General Instructions of the medical fee schedule unless more specific Ground Rules in the medical fee schedule 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 be the maximum fee allowed for the service provided.Section 5.
Services Performed Outside the Boundaries of Kentucky.(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.FILED WITH LRC: October 13, 2026
CONTACT PERSON: B. Dale Hamblin, Jr., Assistant General Counsel, Department of Workers’ Claims. Mayo-Underwood Building, 3rd Floor 500 Mero Street, Frankfort, Kentucky 40601. Telephone Number: (502) 782-4404, Fax Number: (502) 564-0681 Email: Dale.Hamblin@ky.gov