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.   

Provider Enrollment

Enrollment Requirements

An audiologist who is licensed by the Illinois Department of Professional Regulation or their state of practice is eligible to be considered for enrollment and participation in the Department’s Medical Programs. 

A certified hearing instrument dispenser who is not an audiologist but is registered by the Illinois Department of Public Health to dispense hearing aids is eligible to be considered for enrollment to participate in the Department’s Medical Programs. If enrollment is granted, the non-audiologist certified hearing instrument dispenser is enrolled as a medical equipment provider who may provide hearing aids, and hearing aid-related services such as accessories, supplies and repairs. 

An audiologist or certified hearing instrument dispenser who provides hearing aids and hearing aid related services such as accessories, supplies and repairs must also comply with requirements set forth in Chapter M-200, Handbook for Providers of Medical Equipment and Supplies. 

To comply with the Federal Regulations at 42 CFR Part 455 Subpart E - Provider Screening and Enrollment, Illinois has implemented a new electronic provider enrollment system. The web-based system is known as Illinois Medicaid Program Advanced Cloud Technology (IMPACT). 

Illinois IMPACT is a multi-agency effort to replace the Department’s Medicaid Management Information System (MMIS) with a web-based system that meets federal requirements. IMPACT is more convenient for providers and increases efficiency by automating and expediting state agency processes. 

Under the IMPACT system, category of service(s) (COS) is replaced with Specialties and Subspecialties. When enrolling in IMPACT, a Provider Type Specialty must be selected. A provider type subspecialty may or may not be required.

Enrollment Approval

When participation is approved, the provider will receive a computer-generated notification, the Provider Information Sheet, listing certain data on the Department’s computer files. The provider is to review this information for accuracy immediately upon receipt.

If all information is correct, the provider is to retain the Provider Information Sheet for subsequent use in completing claims (billing statements) to ensure that all identifying information required is an exact match to that in the Department files

Enrollment Denial 

When participation is denied, the provider will receive written notification of the reason for denial.

Within ten (10) calendar days after the date of this notice, the provider may request a hearing. The request must be in writing and must contain a brief statement of the basis upon which the Department's action is being challenged. If such a request is not received within ten (10) calendar days, or is received, but later withdrawn, the Department's decision shall be a final and binding administrative determination.

Provider File Maintenance 

The information carried in the Department’s files for participating providers must be maintained on a current basis. The provider and the Department share responsibility for keeping the file updated.

Provider Responsibility 

Information contained on the Provider Information Sheet is the same as in the Department’s files. Each time the provider receives a Provider Information Sheet, it is to be reviewed carefully for accuracy. The Provider Information Sheet contains information to be used by the provider in the preparation of claims; any inaccuracies found must be corrected and the Department notified immediately via IMPACT. 

Failure of a provider to properly update the IMPACT with corrections or changes may cause an interruption in participation and payments.

Department Responsibility 

When there is a change in a provider's enrollment status or the provider submits a change, the Department will generate an updated Provider Information Sheet reflecting the change and the effective date of the change. The updated sheet will be sent to the provider’s office address and to all payees listed if the payee address is different from the provider address.