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
