Schedule of Medical Fees

The Kansas Workers Compensation Schedule of Medical Fees has utilized portions of the following documents:

1. The Current Procedural Terminology, Fourth Edition, copyright 2014 (a.k.a. CPT 2013) by the American Medical Association 

2. The CDT(Current Dental Terminology) Companion, CDT-2013/2014, copyright 2012, published by the American Dental Association 

3. The 2014 Relative Value Guide, copyright 2012, developed by the American Society of Anesthesiologists 

4. The 2014 Essential RBRVS, a comprehensive listing of RBRVS values for CPT and HCPCS Codes, copyright 2013 Ingenix.

5. The January 2014 HCPCS allowances that were obtained from the DMEPOS Fee Schedule of the Centers for Medicare & Medicaid Services (CMS). 

6. Medicare Severity Diagnosis Related Groups (MS-DRGs) Definitions Manual, Version 31.  

Some of the most important revisions that have been utilized within this Schedule of Medical Fees are as follows:

1. The Conversion Factors for all CPT codes in the Medicine and Evaluation and Management Sections have been increased by 3%. 

2. ICD-10 is not mandated by Kansas Workers Compensation. However, 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. 

3. Surgical CPT code 36415 has been moved to the Pathology and Laboratory Section of the fee schedule. 

4. Trauma Alerts in Ground Rule 7 of Inpatient Hospital and Ground Rule 4 of Ambulatory Surgical Centers/Hospital Outpatient are increased by 7%.

5. Compound drugs and physician dispensed medications shall be reimbursed the same as pharmacies based on the original manufacturer NDC but must be preapproved by the payer. 

6. An inpatient stay requires documentation of official admission to the hospital pursuant to an order for inpatient admission by a physician or other qualified practitioner and the order must be present in the medical record.   

This Schedule of Medical Fees governs the medical services provided to injured workers by health care providers including the medical services provided by registered physical and occupational therapists, and the medical services of a hospital or other health care facility; it also governs facilities and agencies providing vocational rehabilitation services. The maximum allowable fees contained within this schedule, which vary by the specific type of service, take into consideration the difficulty in performing a certain type of service that is based upon the risk, time, ability, and skill involved. Note specifically the code designation by type of service being provided. These codes have been adopted by various medical societies and associations (e.g., American Medical Association, American Dental Association) and are to be used in the respective billing or payment of medical services involving injured workers. Note: The maximum allowable payment to a physician is to be limited to the maximum allowable payment contained within the appropriate sections of this fee schedule, regardless of who bills for the service or where the service(s) was/were provided. Billing for all physician services, whether provided in a physician’s office, hospital, or any other setting, must be submitted using the CMS 1500 form or an equivalent form containing the same information. Additionally, and to assure that Cost Containment is achieved, nothing in this fee schedule shall preclude an employer (or insurance carrier) from entering into payment agreements to promote the continuity of care and reduction of health care costs. Such payment agreements, if less, will supersede the limitation amounts specified herein. Please refer to K.S.A. 44-510i(e) for further clarification, if necessary.

All the maximum allowable fees listed herein represent the maximum payment to be reimbursed for the treatment or service provided. With the exception of the payment of selected hospital inpatient services under the diagnosis related group prospective payment system, reimbursement for any needed services is to be limited to the schedule of charges hereby being adopted or the health care provider's billed charge, whichever is less. All bills submitted for payment must include the actual charges plus the categorization of the charges as per the codes contained in this Schedule of Medical Fees. There is a provision, however, for allowing a greater fee if it can be clearly established that extraordinary services were required in a particular case.