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Department of Labor: Division of Industrial Affairs >> Office of Workers' Compensation

HEALTH CARE PAYMENT SYSTEM


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This site contains the official Delaware Office of Workers’ Compensation Health Care fee schedule. This schedule applies to those medical treatments and procedures that are rendered on or after May 23, 2008 and are covered under 19 Del. C. §2322 of the Delaware Workers' Compensation Act. The fees are based on the criteria set forth in the Act.

Employers, insurance carriers, and other workers’ compensation payers shall use this schedule, and its instructions and guidelines, when paying medical charges submitted by physicians, hospitals, or other medical providers for services covered under the Act.

Payment for medical care covered under the Act shall be the lesser of the health care provider's actual charge or the fee set by the schedule. If, however, the employer/insurer and health care provider enter into a contract for different reimbursement levels, those negotiated amounts will prevail.

When possible, this schedule sets a fee for each treatment or facility code in nine categories of service in each geozip where the treatment was provided in Delaware. (Geozip is defined as the first three digits of a zip code). Where there is insufficient data to set a defined amount, then a bill shall be paid at 85% of the actual charge. Please refer to the Instructions and Guidelines for out-of-state treatment information.

This fee schedule site contains four additional pages:

  1. Use & Copyrights This page explains the permitted uses of the data, then explains the permitted uses of the codes associated with the American Medical Association, and the American Society of Anesthesiologists.
  2. Fee Schedule This page allows users to look up various codes and download the entire fee schedule.
  3. Instructions and Guidelines This page contains the instructions and guidelines associated with the fee schedule.
  4. Data Specifications This page describes the computer format of the data.

If you have questions about the fee schedule, please refer to the Frequently Asked Questions page. If you still have questions or want to participate on our e-mail distribution list, e-mail us at hcpaymentquestions@state.de.us.

 
Last Updated: Wednesday, 12-February-2013 14:44:28 EDT
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