69L-7.100: Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs)
69L-7.501: Florida Workers' Compensation Reimbursement Manual for Hospitals
PURPOSE AND EFFECT: To adopt the new versions of the Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers and the Florida Workers’ Compensation Reimbursement Manual for Hospitals, 2006 Editions, to implement the reimbursement rates authorized by the Three-Member Panel pursuant to Section 440.13(12), F.S., at its meeting on April 11, 2006. In addition, the proposed Rule 69L-7.100 will adopt updated versions of the Current Procedural Terminology (CPT®) Manual and the American Medical Association “Healthcare Common Procedure Coding System, Medicare’s National Level II Codes Manual”, and the Current Dental Terminology (CDT-2005), Copyright 2004, American Dental Association, and the Healthcare Common Procedure Coding System (HCPCS) 2006, Eighteenth Edition, Copyright 2005.
SUBJECT AREA TO BE ADDRESSED: Proposed revisions to workers’ compensation reimbursement manuals incorporated by reference into the rules, including amendments to the uniform schedules of maximum reimbursement allowances.
SPECIFIC AUTHORITY: 440.13(14), 440.591 FS.
LAW IMPLEMENTED: 440.13(7), (12), (14) FS.
IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
TIME AND DATE: November 6, 2006, 10:00 a.m.
PLACE: 104J Hartman Building, 2012 Capital Circle SE, Tallahassee, FL
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 5 days before the workshop/meeting by contacting: Don Davis, (850)413-1711. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Don Davis, Division of Workers’ Compensation, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4226, phone (850)413- 1711 or DON.DAVIS@FLDFS.COM.
THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:
69L-7.100
(1) The Florida Workers’ Compensation Reimbursement Manual for 2005 Edition, (ASC Reimbursement Manual) is incorporatedadopted by reference as part of this rule. The ASC Reimbursement Mmanual contains the Maximum Reimbursement Allowances determined by the Three-Member Panel, pursuant to Section 440.13 (12), Florida Statutes and establishes reimbursement policies, guidelines, codes and maximum reimbursement allowances (MRAs) for ambulatory surgical facility services, which are items and services provided to an injured worker in connection with a surgical procedure performed in an Ambulatory Surgical Center. The ASC Reimbursement Mmanual is available for inspection during normal business hours at the Florida Department of Financial Services, Document Processing Section, contains basic instructions and information for all ambulatory surgical centers and insurers concerning reimbursement of claims for ambulatory surgical facility services.
(2) The ASC division has incorporated in the Florida Workers’ Compensation Reimbursement Manual refers to a number of for Ambulatory Surgical Centers, 2005 Edition, procedure codes and modifiers that are consistent with the Physicians’ Current Procedural Terminology (CPT®), developed and published by the American Medical Association. When a service or procedure is performed that does not have a code listed in the ASC Reimbursement Manual, the Ambulatory Surgical Center shall refer to the Current Procedural Terminology (CPT®), 2006 Professional Edition, Copyright 2005, American Medical Association, 2005 Profession Edition, Copyright 2004, American Medical Association. This which is hereby incorporated publication is adopted by reference as part of this rule. When a procedure is performed which is not listed in the manual, the ambulatory surgical center must use the appropriate code and descriptor contained in the Physicians’ Current Procedural Terminology (CPT®), 2005 Professional Edition, Copyright 2004, American Medical Association.
(3) The Current Dental Terminology (CDT-2005), Copyright 2004, American Dental Association, and the Healthcare Common Procedure Coding System (HCPCS) 2006, Eighteenth Edition, Copyright 2005, Ingenix Publishing Group, are incorporated by reference as part of this rule, for dental D codes, injectable J codes, and other medical services or supply codes as specified in the ASC Reimbursement Manual. The Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers, 2005 Edition, incorporated above, is available for inspection during normal business hours at the Florida Department of Financial Services, Document Processing Section,
(4) The
Specific Authority 440.13(4), (14), 440.591 FS. Law Implemented 440.13(7), (12), (14) FS. History–New 8-7-91, Amended 12-31-92, Formerly 38F-7.100, 4L-7.100, Amended 9-4-05, .
69L-7.501
(1) The Florida Workers’ Compensation Reimbursement Manual for Hospitals, 20062004, Second Edition, is adopted by reference as part of this rule. The Hospital Mmanual contains the Maximum Reimbursement Allowances (MRAs) determined by the Three Member Panel, pursuant to Section 440.13(12), Florida Statutes, and establishes reimbursement policyies, procedures, principles and standards for implementing statutory provisions regarding reimbursement for medically necessary services and supplies provided to injured workers in a hospital setting and per diem rates for hospital services and supplies The policy, procedures, principles and standards in the Manual are in addition to the requirements established by the Florida Workers’ Compensation Medical Services Billing, Filing and Reporting Rule, Rule 69L-7.602, F.A.C. The Reimbursement Manual for Hospitals is available for inspection during normal business hours at the Florida Department of Financial Services, Document Processing Section, 200 East Gaines Street, Tallahassee, Florida 32399-0311, or may be obtained free of charge by print or download from the Department’s website at http://www.fldfs.com/wc.
(2) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual [HCP RM], 2006, incorporated by reference into Rule 69L-7.020, F.A.C.; and the Workers’ Compensation Medical Services Billing, Filing and Reporting Rule, Rule 69L-7.602, F.A.C., are also incorporated by reference into this rule. Both rules and the HCP RM are available for inspection during normal business hours at the Florida Department of Financial Services, Document Processing Section, 200 East Gaines Street, Tallahassee, Florida 32399-0311, or via the Department’s web site at http://www.fldfs.com/wc. Form DFS-F5-DWC-90, Uniform Bill (rev. 1992), also known as the UB-92, or HCFA-1450, is hereby incorporated by reference as part of this rule. The Florida Workers’ Compensation Health Care Provider Reimbursement Manual 2004, Second Edition, is incorporated by reference as part of this rule also. The reimbursement policies, billing codes and maximum reimbursement allowances for physical therapy, occupational therapy, speech therapy, radiology and clinical laboratory services contained in the manual shall be applied to hospital services provided on an outpatient basis only.
(3) The Florida Workers’ Compensation Reimbursement Manual for Hospitals, incorporated in subsection (1) above, and Form DWC-90 are available for inspection during normal business hours at the State of Florida Department of Financial Services, Document Processing Section,
Specific Authority 440.13(12), (14), 440.591 FS. Law Implemented 440.13(7), (12), (14), FS. History–New 6-9-87, Amended 6-1-92, 10-27-99, 7-3-01, Formerly 38F-7.501, 4L-7.501, Amended 12-4-03, 1-1-04, 7-4-04,_______________.