A New Benchmark for Workers’ Compensation Fee Schedules: Prices Paid by Commercial Insurers?

By Richard A. Victor, Olesya Fomenko

June 1, 2013 Related Topics: Comparing Group Health and Workers’ Compensation, Fee Schedules, Fee Schedule Benchmarks

In a typical year, 5 to 10 states have significant public policy debates about enacting new fee schedules or making major revisions to existing ones to regulate prices paid in workers’ compensation. Often, the central question debated is what price level is too low—that is, that good health care providers will not provide timely treatment to injured workers.   In making such decisions, providers consider what they are paid by other payors. Prices paid by Medicare and commercial insurers are plausible benchmarks for policymakers to use since they are usually the largest payors in a given state.  

This study compares prices paid by commercial insurers and by workers’ compensation payors for medical services delivered by professionals (not facilities). The study focuses on the median nonhospital price paid for five common surgeries and four common established patient office visits in 22 large states for services delivered in 2009. These are the prices actually paid for professional services billed under a specific Current Procedural Terminology (CPT) code. This study also discusses how to generalize these results to later years. 

The 22 states included in this study are Arizona, Arkansas, California, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Maryland, Massachusetts, Michigan, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia, and Wisconsin.

A New Benchmark for Workers' Compensation Fee Schedules: Prices Paid by Commercial Insurers? WC-13-17. June 2013. 


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