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States often also regulate fees for services provided to injured workers
in an hospital outpatient setting. This table indicates which states
have such fee schedules; the method used to determine allowable fees;
whether the schedule applies to all outpatient services and provides the
appropriate statutory or rule reference if the reader wants additional
information about any particular state regulations. |
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State |
Method Used For Hospital Outpatient Fee Regulations |
All Outpatient Services Are Covered By the Regulations |
Title and Rule Reference Number for Hospital Outpatient Fee Regulation |
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Same as Hospital Inpatient Fees (Fee by Service Code) |
Same as Hospital Inpatient Fees (Cost Based) |
Same as Hospital Inpatient Fees (Discounted Charges) |
Same as Non-Facility Provider Fees (Fee by Procedure Code) |
Use a Varied Method (Explanation in Notes) |
Other |
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Sample State 1 |
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Use Medicare's Outpatient Prospective Payment System pricing methodology
with a higher conversion factor |
Yes |
Medical Aid Rules and Fee Schedule. |
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Sample State2 |
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Maximum fee equals Medicare reimbursement + 35% |
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Statute 23.4.3 and Series 85 Rule 20; Statute 102.16 and Admin. Rules
80.72 and 80.73 |
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Notes: |
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