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.
SUMMARY: Proposed revisions to the Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2007 Edition, incorporated by reference into the rule, including amendments to the uniform schedules of maximum reimbursement allowances.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
SPECIFIC AUTHORITY: 440.13(14)(b), 440.591 FS.
LAW IMPLEMENTED: 440.13(7), (12), (14) FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE,TIME AND PLACE SHOWN BELOW(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):
DATE AND TIME: Wednesday, August 22, 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, Division of Workers’ Compensation, Office of Data Quality and Collection, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4229, phone (850)413-1712. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, (800)955-8771 (TDD) or (800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Don Davis, Division of Workers’ Compensation, Office of Data Quality and Collection, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4229, phone (850)413-1712
THE FULL TEXT OF THE PROPOSED RULE IS:
69L-7.020
(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-2007/20082005, 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,
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,________.