Waltham, MA, June 20, 2025 – As policymakers seek to implement or revise price controls in their state workers’ compensation systems through medical fee schedules, a new study from the Workers Compensation Research Institute (WCRI) highlights the critical design choices involved in adopting, reforming, and updating them.

“The construction of a medical fee schedule in workers’ compensation involves a delicate balance,” said Sebastian Negrusa, WCRI’s vice president of research. “Setting rates too low may make treating injured workers uneconomical for providers and jeopardize access to care. On the other hand, setting rates too high may limit savings and undermine the fee schedule’s cost-containment goals.”

The study, Designing Workers’ Compensation Medical Fee Schedules, 2025, outlines key decisions public officials face when crafting or updating physician fee schedules. It examines how 44 states and the District of Columbia with fee schedules have addressed these challenges as of March 31, 2025, and discusses substantial changes to professional medical service fee schedules since March 2022, focusing on the spillover effect of the relatively high inflation in the general economy. These decisions include the following:

• How high or low the fee schedule should be set
• How frequently fee schedules should be updated and which update approach to adopt
• Whether to base the fee schedule on relative value units (RVUs) or another metric (e.g., historical charges or usual and customary charges)
• If using RVUs, whether to adopt the relative values developed for the Medicare program or another scale
• What share of medical services are without assigned fee schedule rates and how these services should be reimbursed

The study compares fee schedule levels across states for professional services, which account for about 41 percent of workers’ compensation medical costs. It does not assess appropriate rate levels or explore broader policy impacts, such as access to care or patterns of medical utilization.

Click here for more information about this study or to purchase a copy. The authors of the study are Olesya Fomenko and Te-Chun Liu.

ABOUT WCRI:

The Workers Compensation Research Institute (WCRI) is an independent, not-for-profit research organization based in Waltham, MA. Organized in 1983, the Institute does not take positions on the issues it researches; rather, it provides information obtained through studies and data collection efforts, which conform to recognized scientific methods. Objectivity is further ensured through rigorous, unbiased peer review procedures. WCRI's diverse membership includes employers; insurers; governmental entities; managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies in the U.S., Canada, Australia, and New Zealand.

Return to Press Releases listing