Medical treatment provided by Out-of-State Providers

For any service (emergency or non-emergency) that is provided by an out-of-state provider, and if a claim is filed under the Kansas Workers Compensation Law, reimbursement for such service is to be limited to the maximum allowable payment contained within the appropriate sections of this fee schedule. Thus, any out-of-state provider who willingly provides medical service to an injured worker who is seeking benefits under the Kansas Workers Compensation Law, must realize that said service is to be limited to this fee schedule and should take the necessary steps to receive authorization from the insurance company, employer, or payer prior to providing said service. Prior authorization for such services should be obtained to assure that the processing of a Workers Compensation claim will not be denied. Additionally, absent any pre-approval by the insurance company, employer, or payer, balance billing the injured worker, or any other party, for the services provided is prohibited.

Medical treatment requested by employer: In the event an employee is sent by their employer to a health care provider for an evaluation to determine if a medical issue or complaint is work related, the employer/carrier will assume financial responsibility for that visit.  

Medical Treatment Guidelines: The Official Disability Guidelines-Treatment in Workers Compensation (ODG), published by Work Loss Data Institute (WLDI), is to be recognized as the primary standard of reference, at the time of treatment, in determining the frequency and extent of services presumed to be medically necessary and appropriate for compensable injuries under the Kansas Workers Compensation Act, or in resolving such matters in the event a dispute arises. Note that medical treatment guidelines are not requirements, nor are they mandates or standards; they simply provide advice by identifying the care most likely to benefit injured workers. All medical services rendered pursuant to recommended treatment contained in the most recent edition of the ODG are to be presumed reasonable and necessary. The ODG are evidence-based, scientifically valid, outcome-focused, and designed to reduce excessive or inappropriate medical care while safeguarding necessary medical care.

Procedures/Services Listed Without Specified Maximum Allowance: Any service or charge that is not contained within this fee schedule is to be determined by referring to the "Procedures/Services Listed Without Specified Maximum Allowance" rule found within the General Instructions Section

Standardized Billing Form: Health care providers, pharmacists, and suppliers of medical equipment and supplies shall use the CMS 1500 form or an equivalent form containing the same information for the billing of their services, drugs, or supplies. Ambulatory surgical centers/outpatient hospital may use either the CMS 1500 form or the UB-04. Dental offices shall use the ADA-94 form or an equivalent form containing the same information. Hospitals shall use Form UB-04.

 ICD-10 is the 10th revision of the International Classification of Diseases. On October 1, 2015 the ICD-9 code sets are scheduled to be replaced by the ICD-10. During this transition period, a number of healthcare insurance carriers have already begun to utilize and/or recognize the ICD-10 codes. Although not mandated by Kansas Workers Compensation, it is strongly recommended that ICD-10 be employed for billing purposes on the CMS 1500 Form or an equivalent form containing the same information