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COMMISSIONER'S BULLETIN #B-0030-12

November 19, 2012

 

TO: Workers’ Compensation System Participants

RE: Changes to Conversion Factors for Workers’ Compensation Medical Fee Guidelines 28 TAC §134.203 Medical Fee Guideline for Professional Services Chapter 134 – Benefits – Guidelines for Medical Services, Charges and Payments Subchapter C. Medical Fee Guidelines

The purpose of this bulletin is to inform workers’ compensation system participants of the annual change to the Medical Fee Guideline conversion factors as established in 28 Texas Administrative Code (TAC) §134.203. As directed by Texas Labor Code §413.011(a), fee guidelines adopted by the Texas Department of Insurance, Division of Workers’ Compensation (TDI-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 (CMS).

In order to provide predictability and reflect changes in medical service delivery costs to system participants, the TDI-DWC established a conversion factor and an annual update as a part of 28 TAC §134.203. 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 2013 reflects an increase of 0.8%. The following CMS link provides further detail regarding the MEI: http://www.gpo.gov/fdsys/pkg/FR-2012-11-16/pdf/2012-26900.pdf. See Table 86, page 69137 for specific information on the 2013 MEI.

Consequently, for services provided in calendar year 2013, the new Medical Fee Guideline conversion factors in 28 TAC §134.203(c) are $55.30 and $69.43. The conversion factor of $55.30 applies to service categories of Evaluation & Management, General Medicine, Physical Medicine and Rehabilitation, Radiology, Pathology, Anesthesia, and Surgery when performed in an office setting. The conversion factor of $69.43 applies to Surgery when performed in a facility setting.

If there are any questions regarding the information in this bulletin, call the toll-free Comp Connection for Health Care Providers at 1-800-372-7713 or in the Austin area dial 512-804-4000.

Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) Conversion Factors
Conversion Factors To Be Applied For Services Provided Based On The Following Time Frames
Category 1/1/13 – 12/31/13 1/1/12 – 12/31/12 1/1/11 – 12/31/11 1/1/10 – 12/31/10 1/1/09 – 12/31/09 3/1/08 – 12/31/08
Anesthesia $55.30 $54.86 $54.54 $54.32 $53.68 $52.83
Evaluation and Management $55.30 $54.86 $54.54 $54.32 $53.68 $52.83
General Medicine $55.30 $54.86 $54.54 $54.32 $53.68 $52.83
Pathology $55.30 $54.86 $54.54 $54.32 $53.68 $52.83
Physical Medicine and Rehabilitation $55.30 $54.86 $54.54 $54.32 $53.68 $52.83
Radiology $55.30 $54.86 $54.54 $54.32 $53.68 $52.83
Surgery in an office setting $55.30 $54.86 $54.54 $54.32 $53.68 $52.83
Surgery in a facility setting $69.43 $68.88 $68.47 $68.19 $67.38 $66.32
MEI Percentage Adjustment 0.8% 0.6% 0.4% 1.2% 1.6% --

For questions contact:  MedBen@tdi.state.tx.us

 

Rod Bordelon
Commissioner of Workers’ Compensation

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