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OhioBWC - Provider - Service: (Fee Schedule look-up) - Details
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| Fee Schedule look-up |
This table contains information about the fee schedule used by
managed care organizations (MCOs), BWC and self-insuring employers
when reimbursing for services under Ohio's workers' compensation program.
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The fees in this table are for services rendered in the current calendar year.
The table also contains fees for services where just the professional
or technical components were rendered.
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The definitions listed below apply.
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Non-Facility Fee - The reimbursement fee for all bills with
place of service codes 11 (Office), 15 (Mobile Unit) and 20 (Urgent-Care Facility)
for all in-state and out-of-state practitioners.
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Facility Fee - The reimbursement fee for all bills with place
of service codes other than 11 (Office), 15 (Mobile Unit) and 20 (Urgent-Care
Facility) for all in-state and out-of-state practitioners.
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Red - A fee in red indicates the procedure or service is
typically not covered and will not routinely be reimbursed.
Reimbursement is at the discretion of the party responsible
for payment of the bill (i.e., BWC, managed care organization
and self-insuring employer).
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By Report (BR) - No fee is associated with the procedure or
service; therefore, a report is necessary to consider reimbursement.
Reimbursement is at the discretion of the party responsible for
payment of the bill (i.e., BWC, MCO and
self-insuring employer).
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$0.00 (Not Covered) - The procedure or service is not covered
and will not be reimbursed.
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-26 modifier - Professional component reimbursement.
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TC modifier - Technical component reimbursement (i.e., -27 modifier).
Note: Effective April 1, 2002, BWC, MCO or self-insuring employer will not accept -27
modifier. They will only accept a TC modifier.
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Negotiated - Negotiated reimbursement rates are required for
designated all-inclusive per diem codes. The services/supplies
must be medically necessary for treatment of the work-related injury.
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