Bureau Adopts New Fee Schedules

Tuesday, April 24, 2018 | 0

The Ohio Bureau of Workers' Compensation has finalized new medical fee schedules and an outpatient drug formulary, both of which will take effect May 1, the board announced.

The new fee schedules were approved April 20, and include hospital and ambulatory surgical center fees, based on Medicare reimbursement rates. Most categories appear to have changed little from the 2017 fee schedules. Radiology services, for example, which fall under current procedural terminology codes 70010 to 79999, will remain at 142% of the Medicare fee schedule.

Fees for surgery, under codes 10021 to 69990, fell slightly overall, from 220% to 219% of Medicare fees, although many surgery procedures will see slightly higher rates, the schedules show. Incisions and drainage procedures on the skin, under code 10120, for example, rose less than $1, to $320.71 for non-facility fees and $221.78 for facility fees. The bureau offers a fee schedule look-up site.

Ohio's workers' compensation fees are right in the middle of reimbursement rates set by state across the country, according to a 2016 analysis by the Workers' Compensation Research Institute. The study showed that Ohio's fees were just above the median for 31 states included in the analysis.

The bureau also revised its drug formulary, in keeping with recommendations from the bureau's Pharmacy and Therapeutics Committee. 

"These revisions reflect the bureau's dedication to providing for appropriate care while ensuring the safety of our workers," the board's notice reads.