The Colorado Division of Workers’ Compensation (DOWC) recently finalized rule changes that affect workers’ compensation billing, effective Jan. 1, 2022. Pinnacol Assurance will ensure its systems and processes accommodate the rule changes, and we expect no payment disruptions. For more information, we have included the citation references for Rules 16 and 18.
Conversion factors (CFs) for 2022 have been updated. – Rule 18-4(A)(1), p. 5
- Anesthesia $44.18
- Surgery $68.00
- Radiology $68.00
- Pathology $68.00
- Medicine $68.00
- Physical Medicine and Rehabilitation $47.12 (includes Medical Nutrition Therapy and Acupuncture)
- Evaluation & Management (E&M) $54.10
Location 19 off campus-outpatient hospital now pays at the non-facility RVUs. – Rule 18-3(B), p. 4
Significant changes to Current Procedural Terminology® (CPT) guidelines for outpatient evaluation and management (E&M) services. For further details, please review the “2022 Changes to Outpatient Evaluation and Management (E&M)” article. – Rule 18-4(B)(1), pp. 10-11
Definitions for procedures and modalities were added and apply to home physical medicine procedures. - Rule 18-4(H)(4)(a), p. 25
- “Procedure” is any treatment listed in the Medicine/Physical Medicine and Rehabilitation section of CPT®. The term “procedure” includes acupuncture. The billing maximums are per discipline per day unless medical necessity is documented and prior authorization is obtained. The total amount of time spent performing the procedures shall determine the appropriate number of time-based units for a particular visit.
- “Modality” is any treatment listed in the Medicine/Physical Medicine and Rehabilitation section of CPT® under the subheading “Modalities.”
Electrical stimulators that cost more than $300 shall be rented for the first month of use and require documentation of effectiveness prior to purchase. – Rule 18-6(A)(1)(c), p. 41
- TENS units (E720 or E730) will not require a rental prior to purchase.
Auto-shipping of monthly Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) is not allowed. An affirmative request by the injured worker or prescribing Provider is required. Documentation of the request should be sent with the bill. – Rule 18-6(A)(4), p. 42
For inventorial items, “invoice” means a statement given to the Provider by its supplier showing the Provider’s cost of obtaining the item. – Rule 18-6(A)(4), p. 42
The Provider may not charge a fee for a records search and retrieval for the reproduction of the injured worker’s medical record – Rule 18-7(C), p. 51
To be paid for interpreting services at a medical treatment appointment, interpreters must be listed as certified on the Certification Commission for Healthcare Interpreters (CCHI) or the National Board of Certification for Medical Interpreters (National Board) website directory. Certifiable languages include:
For all other languages, or in the event a certified interpreter is unavailable, the interpreter shall be qualified. “Qualified” means the interpreter has documentation showing completion of at least 40 hours of healthcare interpreter training. – Rule 18-7(H)(4), pp. 56-57