This study reports the results of an analysis that shows how the Illinois medical fee schedules for professional services, effective in February 2006, compare with (1) prices actually paid in workers' compensation, (2) Illinois Medicare rates, and (3) workers’ compensation fee schedules in other states.      

Among our findings:

• The Illinois fee schedule, one of the highest in the nation, averaged 167 percent above the Medicare rates in the state.
• Unique in its design, the fee schedule sets different maximum reimbursement rates for the same services for each of 29 different areas of the state.  The areas are defined according to the first three digits of the zip code where the service was delivered.
• The variance in fees among the 29 different areas is wide and for many common services analyzed, the higher fee schedule areas were frequently not the areas where market conditions led to the highest prices having been paid.
• The fee schedule was higher than the average prices paid in Illinois for many services, especially for surgery and radiology.

Analysis of the Workers' Compensation Medical Fee Schedules in Illinois. Stacey Eccleston. July 2006. WC-06-28.

Copyright: WCRI