Utah Admin. Code R612-300-4 - General Method For Computing Medical Fees
A. Adoption of
"CPT" and "RBRVS." The Labor Commission incorporates by reference: CPT 2024 and
Optum Essential RBRVS 2024 annual 1st Quarter Update," edition includes RBRC
23/1120 (RBRVS).
B. Medical fees
calculated according to the RBRVS relative value unit assigned to each CPT
code. Unless some other provision of Title R612 specifies a different method,
the RBRVS is to be used in conjunction with the "conversion factors"
established in Subsection (C) of this rule to calculate payments for medical
care provided to injured workers.
C. Conversion Factors. Fees for medical care
of injured workers shall be computed by determining the relative value unit
(RVU) assigned by the RBRVS to a CPT code and then multiplying that RVU by the
following conversion factors for specific medical specialties:
1. Anesthesiology, 1 unit per 15 minutes of
anesthesia: $75;
2. Medicine,
Evaluation and Medicine codes 99203-99204 and 99213-99214: $62;
3. Medicine, all other Evaluation and
Medicine codes: $59;
4. Pathology
and Laboratory: $63;
5. Radiology:
$65;
6. Restorative Services:
$56;
7. Surgery, all 20000 codes,
codes 49505 thru 49525, and all 60000 codes: $72;
8. Other Surgery: $72.
D. Fees for Medical care not addressed by
CPT/RBRVS, or requiring unusual treatment.
1.
The payor and medical provider may establish and agree to a reasonable fee for
medical care of an injured worker if:
a.
neither the CPT/RBRVS or Title R612 address the medical care in question;
or
b. application of CPT/RBRVS or
Title R612 would result in an inadequate fee due to extraordinary difficulty of
treatment.
2. If the
medical provider and payor cannot agree to a reasonable fee in such cases, the
provider can request a hearing before the Commission's Adjudication Division to
establish a reasonable fee.
Notes
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