| Rule Number: |
26P019 |
| Title: |
Workers' Compensation Medical Fee Schedule Rule 40. |
|
Type:
|
Standard |
|
Status:
|
Proposed |
| Agency: |
Department of Labor
|
| Legal Authority: |
21 V.S.A. Section 640(d) |
| Summary:
| Medical providers who care for injured workers covered by a workers' compensation policy are required to bill for their services using the Workers' Compensation Medical Fee Schedule. It is vital to the health of the workers'compensation system that such fees be sufficient to ensure the provision of services, without being so generous as to increase the cost of insurance coverage. The rule generally modestly raises reimbursement amounts, adds a far more robust table of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes, and provides for annual indexing going forward using Centers for Medicare & Medicaid Services (CMS)"market basket" factors, capped at 3 annually. |
| Persons Affected:
| All Vermont employers required to carry workers' compensation or to self-insure (including the State of Vermont), all Vermont workers who sustain work-related injuries, Vermont health care professionals who care
for injured workers, and all Vermont hospitals. |
| Economic Impact:
| A preliminary analysis by the National Council on Compensation Insurance concluded that the annual impact on workers' compensation system costs would modestly increase reimbursement rates to health care professionals by 3.1. The overall system costs would decrease some 11. The decrease is attributable to more robust CPT and HCPCS billing codes, because procedures with no corresponding fee schedule code are billed at the comparatively high rate of 83 of billed charges. |
| Posting date: |
Jul 01,2026 |
