The Colorado Division of Workers’ Compensation (DOWC) recently finalized rule changes that affect workers’ compensation billing, effective January 1, 2024. Please review the new 2024 guidelines in their entirety. For your convenience, some of the changes to Rule 18 are highlighted below with citation references. 

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Conversion factors (CFs) for 2024 were updated. – Rule 18-4(A)(1), pp. 4-5

• Anesthesia                $44.00
• Surgery/Radiology/Pathology/Medicine (SRPM) $68.00
• Physical Medicine and Rehabilitation         $49.00(includes Medical Nutrition Therapy and Acupuncture)

• Evaluation & Management (E&M) $56.00

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The definition of global days has been updated to a period of time starting with the preoperative period of a surgical procedure and ending some period of time after the procedure was performed. Each surgery code has its own global days period. – Rule 18-4(A)(3)(i), p. 7 

Consultation CPT® code 99241 was deleted from Rule 18. – Rule 18-4(B)(5), p. 12

Providers must bill the CPT® code for prolonged services. – Rule 18-4(B)(6)(c), p. 12

• CPT 99417 – outpatient per 15 minutes
• CPT 99418 – inpatient per 15 minutes
• Do not use HCPCS codes

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The initial functional assessment of pre-injection care related to spinal or SI joint injections may be performed by an injectionist or non-injectionist no more than seven days before the injections. – Rule 18-4(D)(9), p. 17

Telephone services, including those listed in Appendix T and Telephone Services section of CPT®, shall be billed with a modifier 93. Modifier 93 indicates services were performed with no video component. – Rule 18-4(G)(5), p. 22

The modified RVUs for the telephone and online services are:

CPT 99421 Non-facility and facility RVUs are 0.38

CPT 99422 Non-facility and facility RVUs are 0.75

CPT 99423 Non-facility and facility RVUs are 1.19

CPT 99441 Non-facility and facility RVUs are 1.03

CPT 99442 Non-facility and facility RVUs are 1.95

CPT 99443 Non-facility and facility RVUs are 2.86

CPT 98966 Non-facility and facility RVUs are 0.27

CPT 98967 Non-facility and facility RVUs are 0.53

CPT 98968 Non-facility and facility RVUs are 0.75

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The requirement to establish a practitioner/patient relationship through live audio or video for telemedicine was deleted.

Place of service (POS) code 10 was added for telemedicine. POS 10 indicates telehealth was provided in a patient’s home. – Rule 18-4(I)(3)(a), p. 28

The per diem allowances for certain inpatient facilities were updated. – Rule 18-5(A)(2)(b), pp. 29-30

• Skilled nursing facilities are allowed $663 per day.
• Rehabilitation hospitals are allowed $1,479 per day.
• Long-term acute care hospitals are allowed $3,417 per day.

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The multipliers for facility payments were updated:

• Inpatient hospital payments are 160%.  – Rule 18-5(A)(2)(c), p. 30
• Outpatient hospital payments are 160%. – Rule 18-5(B)(3)(b)(i), p. 32
• Ambulatory surgery center (ASC) payments are $150%. – Rule 18-5(B)(3)(b)(iii), p. 32

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Opioid/scheduled controlled substances, including benzodiazepines shall only be provided through a pharmacy. – Rule 18-6(C)(2)(e), p. 44

The Division has created code Z0764 for when an injured worker fails to attend an impairment rating appointment or if the parties notify the physician of a cancellation or reschedule of the appointment five days or less before the appointment. The physician shall be paid one-half of the fee for the scheduled service. – Rule 18-7(F)(4)(b), p. 52

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A few additional things to note regarding changes to the DOWC rules: 

• There are no changes to Rule 16 for services rendered on or after January 1, 2024. 
• The DOWC has a Rule 18 training video outlining several rule changes. It is available on their website.