Florida Workers Compensation Fee Schedule
As a business owner in Florida, it is important to understand the state’s workers compensation fee schedule. In this article, we will take a deeper look at what the fee schedule is, how it works, and its impact on your business.
What is the Florida Workers Compensation Fee Schedule?
The Florida Workers Compensation Fee Schedule is a list of maximum allowable fees that healthcare providers can charge for treating injured workers. The fee schedule applies to all medical services related to workers’ compensation claims.
The fee schedule is designed to control costs and prevent overcharging by healthcare providers. It is also intended to ensure that injured workers receive quality medical care without incurring excessive costs.
How Does the Florida Workers Compensation Fee Schedule Work?
The fee schedule sets maximum allowable fees for medical services based on the Current Procedural Terminology (CPT) codes. Healthcare providers are required to bill their services using the appropriate CPT codes and charge fees according to the fee schedule.
For example, if a healthcare provider charges $200 for a service but the fee schedule allows only $150 for that service, the insurance company will only pay $150. The healthcare provider cannot bill the injured worker for the difference between the allowed fee and the charged fee.
Impact on Employers
The fee schedule can have a significant impact on employers. By controlling costs and preventing overcharging, the fee schedule helps keep workers compensation insurance premiums lower.
However, the fee schedule can also make it more difficult for injured workers to find healthcare providers willing to treat them. Some healthcare providers may not be willing to accept the lower fees set by the fee schedule. This can lead to longer wait times for injured workers to receive medical care.
Events and Competitions
Throughout the year, the Florida Division of Workers’ Compensation hosts events and competitions to provide education and training to employers and healthcare providers on the fee schedule and other workers compensation issues. Some of the events include the Annual Workers’ Compensation Educational Conference and the Healthcare Provider Webinar Series.
Schedule Guide
The fee schedule is updated annually and can be found on the Florida Division of Workers’ Compensation website. The fee schedule is organized by CPT codes and includes the maximum allowable fees for each code. Employers and healthcare providers should refer to the fee schedule when billing or paying for medical services related to workers’ compensation claims.
Schedule Table
| CPT Code | Description | Maximum Allowable Fee |
|---|---|---|
| 99213 | Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes | $75 |
| 99214 | Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes | $125 |
| 97001 | Physical therapy evaluation | $150 |
| 97032 | Application of a modality to 1 or more areas; electrical stimulation (unattended) | $50 |
Question and Answer
Q: Do all healthcare providers have to follow the fee schedule?
A: Yes, all healthcare providers who treat injured workers in Florida are required to follow the fee schedule.
Q: Can healthcare providers charge more than the maximum allowable fee set by the fee schedule?
A: No, healthcare providers cannot charge more than the maximum allowable fee set by the fee schedule.
FAQs
Q: What happens if a healthcare provider charges more than the maximum allowable fee?
A: If a healthcare provider charges more than the maximum allowable fee, the insurance company will only pay the maximum allowable fee. The healthcare provider cannot bill the injured worker for the difference.
Q: How often is the fee schedule updated?
A: The fee schedule is updated annually.
Q: Can injured workers choose their own healthcare provider?
A: Injured workers can choose their own healthcare provider, but the provider must be authorized to treat workers’ compensation patients and must follow the fee schedule.
By understanding the Florida Workers Compensation Fee Schedule, employers can ensure they are following the state’s regulations and controlling costs related to workers’ compensation claims.