The Department of Labor, Division of Industrial Affairs issued a Final Order concerning the revised Fee Schedule Introduction, which became effective February 11, 2024. Please click here for a copy of the Order.

Heckler & Frabizzio’s partner, Anthony Frabizzio serves on the Workers’ Compensation Oversight Panel and participated in making the necessary revisions which were approved.

One of the most important changes includes outpatient facilities being able to be reimbursed for facility charges for multiple-level procedures (see Sections 1.4; old 4.6.2/new 4.7.2; old 4.18.2.3-5/new 4.19.2.3-5).

Other possible impactful changes include:

• new 4.11.2 — CRNA’s paid at the same rate as anesthesiologists.
• old 4.18.2.3-4.18.2.5/new 4.19.2.3-4.19.2.5  — There are 11 codes that moved from $0.00 to POC (64480, 64484, 64491-64492, 64494-64495, 64634, 64636, 77001-77003)
• old 4.6.2-4.6.6/new 4.7.2-4.7.6, old 4.22.1.3/new 4.23.1.3 & old 4.22.5.1.1/new 4.23.5.1.1-4.23.5.1.2 — clarification on using the 2015 status indicators and state comments on these indicators.
• old 4.6.7.8/new 4.7.7.8 – redefining the POC percentage to be as already found in FAQs vs. the listed percent in the narrative.
• old 4.9.3/new 4.10.3 — redefining the POC percentage to be as already found in FAQs vs. the listed percent in the narrative.
• old 4.20.6.5/new 4.21.6.5-4.21.6.6 – changes to moderate sedation (due to CPT changes a few years ago).
• status indicator N does still apply but the state comment does allow for some exceptions if noted in the Fee Schedule. Those exceptions are currently to codes (64480, 64484,64491-64492, 64494-64495, 64634, 64636, 77001-77003) which changed from 0.00 (not covered) to POC.

For more information, please contact Anthony Frabizzio.