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



5221.4005 Instructions for application of fee schedule

Subpart 1. Workers' compensation medical fee schedule; incorporation of Medicare National Physician Relative Value Files. The workers' compensation medical fee schedule consists of items A and B:

A. the tables in the Medicare National Physician Fee Schedule Relative Value File and the Geographic Practice Cost Indices File most recently incorporated by reference by the commissioner by publishing in the State Register pursuant to Minnesota Statutes, section 176.136, subdivision 1a, paragraph (h); and

B. parts 5221.4005 to 5221.4061, which contain instructions for applying the Medicare Physician Fee Schedule tables described in item A to determine the maximum fees for treatment of injured workers under Minnesota Statutes, section 176.136.

Subp. 2. Effective date. The medical fee schedule applies to treatment provided on or after the effective date of:

A. the most recent fee schedule tables adopted pursuant to Minnesota Statutes, section 176.136, subdivision 1a, paragraph (h), as described in subpart 1; and

B. corresponding rules in parts 5221.4005 to 5221.4061 to implement the fee schedule tables.

Subp. 3. Applicability. The medical fee schedule applies to a charge for a particular health care service if:

A. the medical service is compensable under Minnesota Statutes, section 176.135;

B. the service conforms to a CPT, HCPCS, or revenue billing code in effect on the date the service was rendered; and

C. the billing code for the service is listed under the appropriate provider group designation for the health care provider that rendered the service.

Statutory authority:  MS s 14.38; 14.386; 14.388

History:  35 SR 227

Posted:  Sept. 30, 2010

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