Medical Fee Guide Revised

October, 2006

One of the most effective methods in Maryland for controlling workers’ compensation costs is use of the Medical Fee Guide to limit payments for non-hospital medical treatment. The Maryland Workers’ Compensation has worked to find the proper balance between providing injured workers with quality medical care, controlling medical costs for employers and insurers, and providing medical care practitioners with a reasonable financial incentive in order to insure their participation in the system.

In 2004, the Commission determined that all payments under the Medical Fee Guide would be based upon the federal government’s Medicare reimbursement rate for 2004 and medical care providers in Maryland would receive 109% of the 2004 Medicare rate. Some providers, particularly orthopedic surgeons, declined treatment of workers’ compensation patients, which raised concerns as to whether such patients had access to quality medical care.

After studying this issue, the Commission’s Medical Fee Guide Committee recently recommended, and the Commission adopted, an emergency regulation increasing reimbursement rates for certain types of providers. The new regulation took effect on February 1, 2006, and applies to treatment rendered on or after that date. It provides that orthopedic and neurosurgical procedures will be reimbursed at 144% of the 2004 Medicare reimbursement rate, and that facility fees at ambulatory surgery centers will be reimbursed at 125% of the 2004 Medicare reimbursement rate. All other medical procedures covered under the Medical Fee Guide remain at the prior 109% reimbursement rate.

It is hoped by the Commission that these changes will strike the proper balance and encourage providers to participate in the workers’ compensation system, control medical costs for employers and insurers and provide workers’ compensation patients with access to care.