TABLE OF CONTENTS
| Introduction | CPT Codes and Fees / Commission Assigned Codes |
| Evaluation and Management Section 3 | Physical Medicine Section 10 |
| Anesthesia Section 4 | Chiropractic Fee Schedule Section 11 |
| Surgery Section 5 | Industrial Rehabilitation Section 12 |
| Radiology Section 6 | Dental Fee Schedule Section 13 |
| Pathology and Laboratory Section 7 | Hospital and Ambulatory Surgical Center Section 14 |
| Medicine Section 8 | Forms Section 16 |
| Special Services Section 9 | Durable Medical Equipment/Supply Fee Schedule |
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This document introduces Phase One
of the comprehensive revision of the N.C. Industrial
Commission's Medical Fee
Schedule. In Phase Two, we will add fees for the new 2003 Current Procedural Terminology (CPT) codes.
BACKGROUND
On March 1, 1996, the N.C. Industrial
Commission (NCIC) started processing medical bills using the 1996 Medical Fee
Schedule. Medical bills will be approved by the 1996 fee schedule and subsequent
Commission approved updates. Regardless of the date of service, bills will be
processed according to the current schedule and updates unless specific
instructions contained herein define effective dates. The Commission will be
glad to review any medical bills in question.
When processing physician or
professional medical bills, the CPT codes may
be changed only after discussing the proposed change with the Medical Provider
and obtaining an agreement that it can be changed. The medical bill analysis
shall clearly show that the CPT code was changed and shall state the reason.
Request for permission to apply the Fee Schedule and/or questions regarding the application of the Fee Schedule may be directed to the North Carolina Industrial Commission Medical Fees Section.
N.C. Industrial Commission
Medical Fees Section
4337 Mail Service Center
Raleigh, NC 27699-4377
(919) 807-2503
COMMENTS
Codes considered approved “BY REPORT” must be sent to the Chief Medical Fee Examiner marked “PERSONAL”. These bills will be entered on our computer and returned to the Insurance Company or Self-Insurer. The Industrial Commission has given permission for the processor to pay bills without submitting them to the Industrial Commission, for those that are listed as “BY REPORT” if charges don’t exceed $50.00.
NOTES
The Industrial Commission does not allow
for acupuncture and “no show”
visits. Massage Therapy by a licensed massage therapist is paid per agreement.
For CPT code descriptions, please refer to the most current version of the American Medical Association’s Current Procedural Terminology.
Effective March 1, 2001 the Commission deletes all CPT codes not found in
the current AMA listings. Furthermore, the Commission will annually adopt new
codes as well as delete old codes as released by the American Medical
Association.
Jennifer Gudac
Chief Medical Fee Examiner
N.C. Industrial Commission
E-mail: gudaca@ind.commerce.state.nc.us
NOTE 1: To acquire the 1996 North Carolina Workers’ Compensation Medical Fee Schedule, call Medicode at (877) INGENIX (464-3649).
NOTE 2: This page was last revised on March 20, 2003.