Medical Fee Review Section
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
BUREAU OF WORKERS' COMPENSATION
1171 South Cameron Street, Room 305
Harrisburg, PA 17104-2501
Workers Compensation Act 44 and Act 57 provided Employer/Insurers with the opportunity to apply a Medical Fee Schedule to Workers Compensation medical payments.
Included in this site is the 2016 Pennsylvania Workers' Compensation Fee Schedule for Part B providers as well as Tables A through J (Prospective Payment Table, Federal Register Table, Skilled Nursing Facility Table, Home Health Care Agency Table, Ambulatory Surgical Center Table, Ambulatory Surgical Center Table of Providers, Physical Therapy Per Visit Table and Outpatient End Stage-Renal Dialysis Composite Rate, Pharmacy RCC Table and Out-of-State RCC Table). Table I, the Part A Chargemaster, is not available at this site and can be obtained by calling the Bureau's Medical Fee Review Section at 717-787-3486.
Individual Fees can be accessed by HCFA coding and pricing is provided for all Pennsylvania regions where applicable.
Medical providers are required to request payment either on the HCFA form 1500 or the UB92 form, or any successor forms required by HCFA, and shall state their actual charges. The Employer/Insurer to whom the bill is submitted shall calculate the proper amount of payment and supply a written explanation of benefits (EOB) to the provider. Payments for treatment rendered under the act shall be made within 30 days of receipt of the bill and report. If payment is denied entirely, Employers/Insurers shall provide a written explanation for the denial.
If providers do not receive timely or correct payment, an Application for Fee Review may be filed with the Department within 90 days of original billing or 30 days from date of dispute notification.