To amend the rule to adopt the 2007 Edition of the Florida Workers’ Compensation Health Care Provider Reimbursement Manual, to implement the 2007 conversion factors issued by the Centers for Medicare and Medicaid Services approved by the Three ...

DEPARTMENT OF FINANCIAL SERVICES
Divsion of Worker's Compensation

RULE NO: RULE TITLE
69L-7.020: Florida Workers' Compensation Health Care Provider Reimbursement Manual
PURPOSE AND EFFECT: To amend the rule to adopt the 2007 Edition of the Florida Workers’ Compensation Health Care Provider Reimbursement Manual, to implement the 2007 conversion factors issued by the Centers for Medicare and Medicaid Services approved by the Three Member Panel pursuant to Section 440.13(12), F.S. In addition, the proposed amendments to the rule will adopt the CPT® 2007 Current Procedural Terminology Professional Edition, Copyright 2006, American Medical Association; the Current Dental Terminology, CDT-2007/2008, Copyright 2006, American Dental Association; and the “Healthcare Common Procedure Coding System, Medicare’s National Level II Codes, HCPCS 2007”, American Medical Association, Nineteenth Edition, Copyright 2006, Ingenix Publishing Group.
SUBJECT AREA TO BE ADDRESSED: Reimbursement policies, guidelines, codes and maximum reimbursement allowances for services and supplies provided by health care providers to workers’ compensation claimants.
SPECIFIC AUTHORITY: 440.13(14)(b), 440.591 FS.
LAW IMPLEMENTED: 440.13(7), (12), (14) FS.
IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
TIME AND DATE: Tuesday, May 8, 2007; 10:00 a.m.
PLACE: Room 104J, Hartman Bldg., 2012 Capital Circle S.E., Tallahassee, Florida
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 5 days before the workshop/meeting by contacting: Don Davis, [phone]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Don Davis, Division of Workers’ Compensation, Office of Data Quality and Collection, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4226, [phone]

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

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

(1) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2007 2006 Edition, is adopted by reference as part of this rule. The manual contains the Maximum Reimbursement Allowances determined by the Three-Member Panel, pursuant to Section 440.13(12), F.S., and 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.

(2) The CPT^®® 20076 Current Procedural Terminology Professional Edition, Copyright 20065, American Medical Association; the Current Dental Terminology, CDT-2007/2008 2005, Copyright 20064, American Dental Association; and in part for D codes and for injectable J codes, and for other medical services and supply codes, the “Healthcare Common Procedure Coding System, Medicare’s National Level II Codes, HCPCS 20076”, American Medical Association, Nineteenth Eighteenth Edition, Copyright 20065, Ingenix Publishing Group, 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, 2007 2006 Edition incorporated above, the provider must use a code contained in the CPT^®® 20076, CDT-2007/2008 2005 or HCPCS-20076 as specified in this section.

(3) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2007 2006 Edition incorporated above, is available for inspection during normal business hours at the Florida Department of Financial Services, Document Processing Section, 200 East Gaines Street, Tallahassee, Florida 32399-0311, or via the Department’s web site at http://www.fldfs.com/wc.

Specific Authority 440.13(14)(b), 440.591 FS. Law Implemented 440.13(7), (12), (14) 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,__________.