Question Workmans Comp - MD - 97750

[mhughes0301]

We do Functional Capacity Evaluations (FCE). I informed the providers that 97750 is the correct code for performing FCE's and that the written report is included in the code. As the MUE's are (8) total units, the provider states that is not what he has been getting reimbursed for for FCE's for the past (9) years. However, we have noticed the code he was using has not been getting paid as it is the incorrect code. Provider states the test takes (4) hours, and 8 units would only give him payment for (2) of them. My question is, is anyone else using a code that is getting paid by the WCC other than 97750 to give the provider proper reimbursement for his (4) hours of work?

 

[TThivierge]

Mhughes
Is the provider using a definitive dx not unspecified one or just Z dx code? Are modifiers G0, GP and GN listed.....is the referring doc on the claim and last time or first time pt got Phy Ther on this specific medical issues? Also is the dx matching the work comp claim dx? I hope this data helps you
Lady T

 

[Lauren423]

97750 is the correct code for FCE, but each state has their own rules implemented by their WC commission. The reimbursement for an FCE in MD that is performed over four hours is $1,055.98. This is per Maryland Worker' Compensation Medical Fee Schedule. This should be billed with 97799 with modifier 02 per MD's WC website. MUE is not applicable since WC has their own guideline for your state. Here is the link to the PDF. I have also attached this doc.