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Florida Administrative Code (Last Updated: November 11, 2024) |
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69. Department of Financial Services |
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69L. Division of Workers' Compensation |
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69L-7. Workers' Compensation Medical Reimbursement And Utilization Review |
1(1) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2020 Edition, 13to 14become effective July 1, 2022, 19is incorporated 21by reference as part of this rule. The HCP RM contains the Maximum Reimbursement Allowances (MRAs) determined by the Three-Member Panel, pursuant to section 45440.13(12), F.S., 47and establishes reimbursement policies, guidelines, codes, and MRAs for services provided by health care providers. Also, the HCP RM includes reimbursement policies and payment methodologies for pharmacists and medical suppliers. The policies and procedures in the HCP RM are in addition to the requirements and responsibilities established throught rule Chapter 69L-7, F.A.C., Workers’ Compensation Medical Reimbursement and Utilization Review.
106(2) The 108Current Procedural Terminology (CPT112®113), 2020 115Professional Edition, Copyright 2019, American Medical Association; the CDT 2020, 125Dental Procedure Codes, 128Copyright 2020, American Dental Association; in part, for D codes and for injectable J codes, and for other medical services and supply codes, the 152HCPCS Level II, Professional 2020 edition, 158American Medical Association, Copyright 2020, 163Elsevier Inc.; the CPT167® 168Assistant 2020, American Medical Association, Copyright 2019; and the ICD-10-CM 2020: The Complete Official Codebook, American Medical Association, Copyright 2019, Optum360, LLC, are incorporated by reference as part of this rule. A copy of the American Medical Association reference materials may be obtained from the American Medical Association’s website at https://commerce.ama-assn.org/store/. A copy of the CDT reference material may be obtained from the American Dental Association’s website at https://www.ada.org/en/publications/ada-catalog.
237(3) Posting the copyrighted materials in subsection (2) above and the HCP RM on the Internet would constitute a violation of federal copyright law. These materials are available for public inspection and examination, but may not be copied, during normal business hours at: (a) the Florida Department of Financial Services, Division of Workers’ Compensation, 291Bureau of Monitoring and Audit, 1579 Summit Lake Drive, 300Tallahassee, Florida 32317, or (b) the Florida Department of State, R.A. Gray Building, 500 South Bronough Street, Tallahassee, Florida 32399-0250. In addition, the HCP RM may be obtained via the Department’s Division of Workers’ Compensation website at 337https://www.myfloridacfo.com/Division/wc/.
338Rulemaking Authority 340440.13(13)(b), 341440.591 FS. 343Law Implemented 345440.13(7), 346(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, 7-1-23.
383Editorial Note: 385Ratified by Ch. 2016-203, LOF, Ch. 2023-144, LOF.
