Haw. Code R. § 12-15-90 - Workers' compensation medical fee schedule
(a) Charges
for medical services shall not exceed one hundred ten per cent of participating
fees prescribed in the Medicare Resource Based Relative Value Scale System fee
schedule (Medicare Fee Schedule) applicable to Hawaii or listed in exhibit A,
located at the end of this chapter and made a part of this chapter, entitled
"Workers' Compensation Supplemental Medical Fee Schedule", dated January 1,
2018. The Medicare Fee Schedule in effect on January 1, 1995 shall be
applicable through June 30, 1996. Beginning July 1, 1996 and each calendar year
thereafter, the Medicare Fee Schedule in effect as of January 1 of that year
shall be the effective fee schedule for that calendar year.
(b) If maximum allowable fees for medical
services are listed in both the Medicare Fee Schedule and the Workers'
Compensation Supplemental Medical Fee Schedule, dated January 1, 2018, located
at the end of this chapter as exhibit A, charges shall not exceed the maximum
allowable fees allowed under the Workers' Compensation Supplemental Medical Fee
Schedule, dated January 1, 2018, located at the end of this chapter as exhibit
A.
(c) If the charges are not
listed in the Medicare Fee Schedule or in the Workers' Compensation
Supplemental Medical Fee Schedule, dated January 1, 2018, located at the end of
this chapter as exhibit A, the provider of service shall charge a fee not to
exceed the lowest fee received by the provider of service for the same service
rendered to private patients. Upon request by the director or the employer, a
provider of service shall submit a statement to the requesting party, itemizing
the lowest fee received for the same health care, services, and supplies
furnished to any private patient during the one-year period preceding the date
of a particular charge. Requests shall be submitted in writing within twenty
calendar days of receipt of a questionable charge. The provider of service
shall reply in writing within thirty-one calendar days of receipt of the
request. Failure to comply with the request of the employer or the director
shall be reason for the employer or the director to deny payment.
(d) Fees listed in the Medicare Fee Schedule
shall be subject to the current Medicare Fee Schedule bundling and global rules
if not specifically addressed in these rules. The Health Care Financing
Administration Common Procedure Coding System (HCPCS) alphabet codes adopted by
Medicare will not be allowed, except for injections and durable medical
equipment, unless specifically adopted by the director. The director may defer
to a fee listed in the Medicare HCPCS Fee Schedule when a fee is not listed in
the Workers' Compensation Supplemental Medical Fee Schedule, Exhibit
A.
(e) Providers of service will be
allowed to add the applicable Hawaii general excise tax to their
billing.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.