69L-7.020. Florida Workers' Compensation Health Care Provider Reimbursement Manual  


Effective on Saturday, July 1, 2017
  • 1(1) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2016 Edition, 13to 14become effective July 1, 2017, 19http://www.flrules.org/Gateway/reference.asp?No=Ref-0217685, 22is adopted 24by reference as part of this rule. The manual contains the Maximum Reimbursement Allowances determined by the Three-Member Panel, pursuant to subsection 46440.13(12), F.S., 48and establishes reimbursement policies, guidelines, codes and maximum reimbursement allowances for services and supplies provided by health care providers. Also, the manual includes reimbursement policies and payment methodologies for pharmacists and medical suppliers.

    81(2) The 83CPT84® 852016 Current Procedural Terminology 89Professional Edition, Copyright 2015, American Medical Association; the CDT 2016, 99Dental Procedure Codes 102Copyright 2015, American Dental Association; and, in part, for D codes and for injectable J codes, and for other medical services and supply codes, the “1282016 HCPCS Level II Professional Edition,134” American Medical Association, Copyright 2016, 140Elsevier Inc., are adopted by reference as part of this rule. When a health care provider performs a procedure or service which is not listed in the Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2016 Edition, incorporated above, the provider must use a code contained in the CPT189® 1902016, CDT 2016 or HCPCS 2016 as specified in this section. The CPT203® 204Assistant, American Medical Association, Copyright 2015, and the 2016 ICD-10-CM: The Complete Official Codebook, American Medical Association, Copyright 2015, Optum360, LLC, are also adopted by reference as part of this rule. A copy of these reference materials may be obtained from the American Medical Association’s website at https://commerce.ama-assn.org/store/. A copy of the CDP reference material may be obtained from the American Medical Association’s website at http://www.ada.org/en/publications/ada-catalog. A copy of the HCPCS Legel II reference material may be obtained from the American Medical Association’s webiste at http://commerce.ama-assn.org/store/.

    290(3) The posting of the preceding copyrighted materials on the internet would constitute a violation of the federal copyright law. The preceding copyrighted materials are available for public inspection and examination, but may not be copied, during normal business hours at the Florida Department of Financial Services, Division of Workers’ Compensation, 341Tallahassee, Florida. The preceding non-copyrighted materials may be accessed online via the Department’s Division of Workers’ Compensation website at 360http://www.myfloridacfo.com/Division/wc/.

    361Rulemaking Authority 363440.13(13)(b), 364440.591 FS. 366Law Implemented 368440.13(7), 369(12), (13)(b) FS. History–New 10-1-82, Amended 3-16-83, 11-6-83, 5-21-85, Formerly 38F-7.20, Amended 4-1-88, 7-20-88, 6-1-91, 4-29-92, 2-18-96, 9-1-97, 12-15-97, 9-17-98, 9-30-01, 7-7-02, Formerly 38F-7.020, 4L-7.020, Amended 12-4-03, 1-1-04, 7-4-04, 5-9-05, 9-4-05, 11-16-06, 10-18-07, 2-4-09, 7-1-16, 7-1-17.
    405Editorial Note: 407Ratified by Ch. 2016-203, LOF.

     

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