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Workers' compensation -- HIPAA 835 Health care claim payment/remittance advice



5221.4010 Employer's liability for services under medical fee schedule

Unless the maximum fee is adjusted under part 5221.4035, 5221.4051 or 5221.4061, the employer's liability for services included in parts 5221.4030 to 5221.4061 is limited to 100 percent of the fee schedule amount calculated according to the formula in part 5221.4020 or the provider's usual and customary fee for the service, whichever is lower. The employer's liability for pharmacy services is as provided in part 5221.4070.

Statutory authority:  MS s 14.38; 14.386; 14.388; 175.171; 176.101; 176.135; 176.1351; 176.136; 176.231; 176.83

History:  18 SR 1472; 25 SR 1142; 35 SR 227

Posted:  Sept. 30, 2010

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