This bulletin informs workers’ compensation system participants of the annual change to the Medical Fee Guideline conversion factors 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 2019 reflects an increase of 1.5 percent.
For services provided in calendar year 2019, the new Medical Fee Guideline conversion factors are $59.19 and $74.29. The conversion factor of $59.19 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 $74.29 applies to surgery when performed in a facility setting.
If there are any questions about the information in this bulletin, call Comp Connection for Health Care Providers at 800-372-7713.
Commissioner of Workers’ CompensationCY2019 Table of Conversion Factors