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TDI Commissioner Bulletin B 0075 008

November 21, 2008                                                  Bulletin 2008-No. 10

 

On November 20, 2008, Workers’ Compensation Commissioner Rod Bordelon issued Commissioner’s Bulletin B-0075-08.  The full text of the Bulletin B-0075-08 follows:

 

TO: Workers’ Compensation System Participants

 

RE: Changes to Conversion Factors for Workers’ Compensation Medical Fee Guidelines 28 TAC §134.203 Medical Fee Guidelines 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 system participants of the annual change to the Medical Fee Guideline conversion factors as established in 28 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 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, TDI-DWC established a conversion factor and an annual update as a part of §134.203.  The annual update is based on the Medicare Economic Index (MEI), which reflects price changes for goods and services used to deliver physician services.  The MEI, reported as 1.6% increase for 2009, is a weighted average of price changes for goods and services used to deliver physician services.  The following link provides further detail regarding the MEI:

 

http://www.cms.hhs.gov/PhysicianFeeSched/PFSFRN/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=4&sortOrder=descending&

itemID=CMS1216674&intNumPerPage=10

 

Consequently, for services provided in calendar year 2009, the new Medical Fee Guideline conversion factors in §134.203(c) are $53.68 and $67.38.  The conversion factor of $53.68 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 $67.38 applies to Surgery when performed in a facility setting.

 

If there are any questions regarding the information in this bulletin, please contact Ruth Richardson, Manager of Healthcare Policy and Implementation, at (512) 804-4850 or send email to: MedBen@tdi.state.tx.us.

 

 

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