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Medical services pricing in comp varies among states: Study

medical fee schedules

States that don’t have workers compensation medical fee schedules for professional services tend to have much higher prices compared with states that have fee schedules, according to updated findings by the Workers Compensation Research Institute.

The WCRI on Thursday released the updated version of its ongoing study, WCRI Medical Price Index for Workers’ Compensation, which looks at a variety of professional services billed by physicians, physical therapists and chiropractors treating injured workers.

Researchers found prices paid for a similar set of professional services in comp varied drastically between the 36 states making up the study group, mostly depending on whether fee schedules are in place.

This ranged from 31 percent below the median in Florida to 163 percent above the median in Wisconsin.

Researchers, who monitored price changes between 2008 and 2022, also found many states saw significant price growth for evaluation and management services beginning in 2021, after the Centers for Medicare & Medicaid Services revised its fee schedules and the American Medical Association updated its coding guidelines.

Professional services include evaluation, management, physical medicine, surgery, radiology, neurological testing, pain management injections and emergency care.

The study said eight states that implemented major fee schedule changes during the study period – Arizona, Illinois, Kentucky, Massachusetts, New York, North Carolina, Texas and Virginia – had significant changes in overall prices paid for comp medical services.

The 36 states in the study represent 87% of all comp benefits paid in the U.S.