To adopt the new versions of the Florida Workers’ Compensation Reimbursement Manual for Health Care Providers and the Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers, 2010 Editions, and to implement the ...

DEPARTMENT OF FINANCIAL SERVICES
Division of Worker's Compensation

Rule No.: RULE TITLE
69L-7.020: Florida Workers' Compensation Health Care Provider Reimbursement Manual
69L-7.100: Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs)
PURPOSE AND EFFECT: To adopt the new versions of the Florida Workers’ Compensation Reimbursement Manual for Health Care Providers and the Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers, 2010 Editions, and to implement the reimbursement rates authorized by the Three Member Panel, pursuant to Section 440.13(12), F.S., at its meeting on December 18, 2009. In addition, both proposed rules will adopt updated versions of the America Medical Association Current Procedural Terminology, CPT© 2010 Professional Edition, Copyright 2009, the American Medical Association’s “Healthcare Common Procedure Coding System, Medicare’s National Level II Codes Manual” HCPCS 2010, Copyright 2009, Ingenix Publishing Group, and the American Dental Association Current Dental Terminology, CDT® 2009/2010, Copyright 2008.
SUBJECT AREA TO BE ADDRESSED: Reimbursement to health care providers and ambulatory surgical centers for services performed for injured workers pursuant to Section 440.13, Florida Statutes.
SPECIFIC AUTHORITY: 440.13(4), (14)(b), 440.591 FS.
LAW IMPLEMENTED: 440.13(7), (12), (14)(c) 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: Thursday, September 16, 2010, 9:00 a.m. –10:30 a.m. and 11:00 a.m. – 12:30 p.m.
PLACE: Room 104J, Hartman Building., 2012 Capital Circle Southeast, 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: Samuel Willis III, [phone] or [e-mail]. 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: Samuel Willis III, Medical/Health Care Analyst, Division of Workers’ Compensation, Office of Medical Services, Department of Financial Services, 200 E. Gaines Street, Tallahassee, Florida 32399-4226, [phone], [e-mail]

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, 2010 2008 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^® 2010 2009 Current Procedural Terminology Professional Edition, Copyright 2009 2008, American Medical Association; the Current Dental Terminology, CDT-2009/2010 2007/2008, Copyright 2008 2006, 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 2010 2009”, American Medical Association, Twenty-first Edition, Copyright 2009 2008, 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, 2010 2008 Edition incorporated above, the provider must use a code contained in the CPT^®-2010 2009, CDT-2009/2010 2007/2008 or HCPCS-2010 2009 as specified in this section.

(3) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2010 2008 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.

Rulemaking Specific Authority 440.13(14)(b), 440.591 FS. Law Implemented 440.13(7), (12), (14)(c) 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,_________.

 

69L-7.100 Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs).

(1) The Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers, 2010 2006 Edition, (ASC Reimbursement Manual) is incorporated by reference as part of this rule. The ASC Reimbursement Manual contains the Maximum Reimbursement Allowances determined by the Three-Member Panel, pursuant to Section 440.13(12), Florida Statutes and establishes reimbursement policies, guidelines, codes and maximum reimbursement allowances (MRAs) for services provided to an injured worker in connection with a surgical procedure performed in an Ambulatory Surgical Center. The ASC Reimbursement Manual 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.

(2) The ASC Reimbursement Manual refers to a number of procedure codes and modifiers that are consistent with the Current Procedural Terminology (CPT^®), developed and published by the American Medical Association. When a service or procedure is performed that does not have a code listed in the ASC Reimbursement Manual, the Ambulatory Surgical Center shall refer to the Current Procedural Terminology (CPT^®), 2010 2007 Copyright 2009 2006, American Medical Association, which is hereby incorporated by reference as part of this rule.

(3) The Current Dental Terminology (CDT-2009/2010 2007/2008), Copyright 2008 2006, American Dental Association, and the Healthcare Common Procedure Coding System, Medicare’s National Level II Codes, HCPCS 2010 2007, Twenty-second Nineteenth Edition, Copyright 2009 2006, Ingenix Publishing Group, are incorporated by reference as part of this rule, for dental D codes, injectable J codes, and other medical services or supply codes as specified in the ASC Reimbursement Manual.

(4) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2010 2006, incorporated by reference into Rule 69L-7.020, F.A.C., is also incorporated by reference into this rule. The Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2010 2006, 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.

Rulemaking Specific Authority 440.13(4), (14), 440.591 FS. Law Implemented 440.13(7), (12), (14) FS. History–New 8-7-91, Amended 12-31-92, Formerly 38F-7.100, 4L-7.100, Amended 9-4-05,_________.