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 TAC §134.203. Under 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.
To provide predictability and reflect changes in medical service delivery costs to system participants, TDI-DWC established a conversion factor and an annual update as part of 28 TAC §134.203(c). 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 2016 reflects an increase of 1.1 percent.
For services provided in calendar year 2016, the new Medical Fee Guideline conversion factors are $56.82 and $71.32. The conversion factor of $56.82 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 $71.32 applies to surgery when performed in a facility setting.
A table reflecting the conversion factors from 2008 through 2016 can be found on TDI-DWC’s website at the following address: www.tdi.texas.gov/wc/fee/. If there are any questions about the information in this bulletin, call the toll-free Comp Connection for Health Care Providers at (800) 372-7713.
W. Ryan Brannan
Commissioner of Workers' Compensation
Conversion Table in PDF