Connecticut Fee Schedule Rates Compared to State Medicare Rates: Common Medical Services Delivered to Injured Workers by Nonhospital Providers

By Stacey M. Eccleston

December 1, 2007 Related Topics: Fee Schedules

This WCRI FLASHREPORT was prepared at the request of the Connecticut Workers’ Compensation Commission to assist in evaluating changes to the fee schedule.

The report compares the 2007 Connecticut workers’ compensation fee schedule for nonhospital providers with the Medicare fee schedule in Connecticut for nonhospital providers. It also provides information on the most commonly used medical services used to treat injured workers in Connecticut and paid for under workers’ compensation. 

In general, the Connecticut fee schedule is much higher than Medicare for surgery and specialty care. For common surgeries, the workers' compensation fee schedule is often more than triple the state's Medicare rates. Illustrative examples:

  • The fee schedule rates for arthroscopy knee surgery (CPT code 29881) and for arthroscopy shoulder surgery (CPT code 29826) are $2,885 and $3,313, respectively, exceeding the Medicare rates by 345 percent or more.
  • At $5,493, a lumbar laminotomy (CPT code 63030) exceeds the Connecticut Medicare fee schedule rate by 484 percent.

The study does not analyze what an ideal structure or level of a fee schedule should be, nor does it analyze the implications of a change in the fee schedule on employers’ costs or workers’ access to care.

FlashReport: Connecticut Fee Schedule Rates Compared to State Medicare Rates: Common Medical Services Delivered to Injured Workers by Nonhospital Providers. Stacey M. Eccleston. December 2007. FR-07-04.

 

Copyright: WCRI

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