What is the correct fee schedule amount to be charged for a medical service or procedure that does not have a specific unit value listed in the Workers Compensation Board Medical Fee Schedule?
• Ans: Although most medical services and procedures are included within the Workers’ Compensation Board Medical Fee Schedule, certain services are relatively unique in nature and do not have a specific unit value indicated within the fee schedule. These procedures are referred to as BR, or ‘by report’ items. Fees for such services must be justified by the submission of a written report. The provider shall establish a unit value consistent in relativity with other unit values shown in the fee schedule. If the health provider and the No-Fault insurer cannot agree on the correct level of reimbursement for services rendered, that would constitute a question of fact which should be submitted to No-Fault arbitration or a court of competent jurisdiction for resolution.
Related Questions
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