How Does the Massachusetts Medical Fee Schedule Compare to Prices Actually Paid in Workers’ Compensation?

By Stacey M. Eccleston

April 1, 2006 Related Topics: Fee Schedules

This study reports the results of an analysis requested by the Commonwealth of Massachusetts (Department of Industrial Accidents and Division of Health Care Finance and Policy) for information that may provide input to their decisions about a revised medical fee schedule. 

The report shows how the medical fee schedule in Massachusetts, the lowest in the nation, compares with prices actually paid in workers' compensation. It also compares the Massachusetts fee schedule to the medical fee schedules in nearby states (Connecticut, Maine, New York, Rhode Island, Vermont). 

The study examines common medical procedures delivered to injured workers and paid for under workers’ compensation in Massachusetts. Services examined include:

  • physician services – surgical
  • physician services – nonsurgical
  • physical/occupational therapist services
  • chiropractic services 

Among our findings:

  • Unlike most other physician-billed services, major surgical procedures were often paid above the fee schedule.  For many of these procedures, it was not uncommon for the median payment for a procedure to be two or three times the fee schedule amount.
  • The majority of non-surgical physician services were paid at or below the applicable fee schedule amount.
  • The majority (90 percent or more) of payments for physical/occupational therapists’ services were made at or below the applicable fee schedule level.
  • For chiropractic services, 95 percent of services were paid at or below the applicable fee schedule level.

 How Does the Massachusetts Medical Fee Schedule Compare to Prices Actually Paid in Workers' Compensation?. Stacey Eccleston. April 2006. WC-06-27.

Copyright: WCRI

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