The Medical Fee Guideline conversion factors are established by 28 Texas Administrative Code §134.203. Under Labor Code §413.011(a), fee guidelines adopted by the Division of Workers’ Compensation (DWC) for non-network services and approved out-of-network services are based on the most current reimbursement methodologies, models, and values or weights used by the federal Centers for Medicare and Medicaid Services.
DWC established a conversion factor and an annual update to provide predictability and reflect changes in medical service delivery costs to system participants. The annual update is based on the Medicare Economic Index (MEI), which is a weighted average of price changes for goods and services used to deliver physician services. The MEI for 2024 reflects an increase of 4.6 percent.
For services provided in calendar year 2024, the new Medical Fee Guideline conversion factors are $67.81 and $85.12. The conversion factor of $67.81 applies to service categories of evaluation and management, general medicine, physical medicine and rehabilitation, radiology, pathology, anesthesia, and surgery when performed in an office setting. The conversion factor of $85.12 applies to surgery when performed in a facility setting.
Questions? Call Comp Connection for Health Care Providers at 800-252-7031 option 3, or email CompConnection@tdi.texas.gov.
| Applicable from | Applicable to | Anesthesia | Evaluation and management | General medicine | Pathology | Physical medicine and rehabilitation | Radiology | Surgery in an office setting | Surgery in a facility setting | MEI percentage adjustment |
|---|---|---|---|---|---|---|---|---|---|---|
| 1/1/24 | 12/31/24 | $67.81 | $67.81 | $67.81 | $67.81 | $67.81 | $67.81 | $67.81 | $85.12 | 4.6% |
| 1/1/23 | 12/31/23 | $64.83 | $64.83 | $64.83 | $64.83 | $64.83 | $64.83 | $64.83 | $81.38 | 3.8% |
| 1/1/22 | 12/31/22 | $62.46 | $62.46 | $62.46 | $62.46 | $62.46 | $62.46 | $62.46 | $78.37 | 2.1% |
| 1/1/21 | 12/31/21 | $61.17 | $61.17 | $61.17 | $61.17 | $61.17 | $61.17 | $61.17 | $76.76 | 1.4% |
| 1/1/20 | 12/31/20 | $60.32 | $60.32 | $60.32 | $60.32 | $60.32 | $60.32 | $60.32 | $75.70 | 1.9% |
Exam fees
DWC adopted amendments to 28 Texas Administrative Code (TAC) Chapter 133, General Medical Provisions and 28 TAC Chapter 134, Benefits--Guidelines for Medical Services, Charges, and Payments to improve billing and reimbursement for certain workers' compensation-specific services, including designated doctor (DD) examinations, required medical examinations (RMEs), and maximum medical improvement (MMI) evaluations and impairment rating (IR) examinations by treating and referred doctors.
Revised billing requirements are effective for services assigned by the division after June 1, 2024. New rates are effective for exams conducted on or after June 1, 2024. These rates will be adjusted annually on January 1 by the Medicare Economic Index.
Exams conducted prior to June 1, 2024 will be reimbursed according to the prior rates and methodologies such as tiering or range of motion.
| Applicable Dates of Service | 3/1/2008 to 5/31/2024 | 6/1/2024 to 12/31/2024 |
|---|---|---|
| Annual MEI percentage | n/a | n/a |
| Maximum Medical Improvement Exam by Referral Doctor/RME Doctor/DD | $350.00 | $449.00 |
| Impairment Rating Exam by Treating Doctor/Referral Doctor/RME Doctor/DD | $300.00 | $385.00 |
| Additional IR Area Exam by Treating Doctor/Referral Doctor/RME Doctor/DD | $150.00 | $192.00 |
| Extent of Injury Exam by RME Doctor/DD | $500.00 | $642.00 |
| Disability Exam by RME Doctor/DD | $500.00 | $642.00 |
| Return to Work Exam by RME Doctor/DD | $500.00 | $642.00 |
| Other Exam by RME Doctor/DD | $500.00 | $642.00 |
| Missed Appointement (DD ONLY)$100.00 | n/a | n/a |
| Specialist Required (DD ONLY) | n/a | $300.00 |
| Appropriatness of Medical Care (RME DOCTOR ONLY) | $500.00 | $642.00 |