“I qualify for workers’ compensation, so when will I be paid?”
The Arizona fee schedule is an important resource for anyone involved with the workers’ compensation system. Insurers, employers, healthcare providers and injured workers should be aware of what the fee schedule is and why it matters.
Find out the answers to frequently asked questions below.
Q: What is the Arizona workers’ compensation fee schedule?
This document regulates what medical providers get paid for providing treatment for a work-related injury or illness. When an employee gets injured, they go to a care provider for treatment. The fee schedule lists what the healthcare provider gets paid for providing a particular service. The rates are set in advance by the Industrial Commission of Arizona (ICA).
Q: Who creates the fee schedule?
The ICA creates Arizona’s fee schedule. The Industrial Commission is a government agency that oversees and manages many issues relating to labor in Arizona, including workers’ compensation.
Q: How is the fee schedule determined?
To determine the fee schedule, the Commission looks at rates used for similar treatment. For example, they consider Medicare rates, federal workers’ compensation program rates and other applicable maximum allowable rates. The public has the opportunity to give input into the rates as well. Changes become effective each October after a public hearing.
Q: How often is the fee schedule updated?
The ICA updates the workers’ compensation fee schedule every year. The changes become effective October 1 of each year. In the spring, the Commission posts recommended changes to their website and they finalize the changes after accepting public comments.
Q: Do I have to pay if there is a fee dispute?
In short, no. The insurance company and the provider must resolve a fee dispute between themselves. The central purpose of the workers’ compensation system is to provide medical care to an injured worker at no cost to the worker. For that reason, the provider and the insurance company may not involve the injured worker in a pay dispute.
Q: What’s not included in the fee schedule?
Some services that are not included in the fee schedule include:
- Ambulances
- Durable medical equipment
- Prosthetics
- Orthotics
If a service or type of medical equipment is not covered, the Commission cannot set a fee or resolve a fee dispute.
Q: What is the law for workers’ compensation billing?
Arizona Revised Statutes section 23-1062.01 is the law for workers’ compensation billing. In order to receive payment, the healthcare provider must submit a bill that follows the criteria. The law gives timeframes for submitting bills. There are also criteria for denying a bill.
When submitting a bill, it must have the correct patient and provider information. In addition, they must provide their taxpayer identification number. Accurate medical coding and legible medical reports for each date of service are also mandatory.
Q: Does the fee schedule cover out-of-state providers?
Yes, it does. Anyone who provides medical services to an injured employer must follow the fee schedule. The fee schedule applies to any covered employee who receives treatment, even if they receive treatment out of state.
Are chiropractors covered by the workers’ compensation fee schedule?
Yes, they are. The fee schedule contains specific rates for chiropractic services. In the absence of an agreement for a different reimbursement amount, chiropractors may submit billing for payment according to stated rates.
Q: Are physical therapists covered by the fee schedule?
Yes. The Workers’ Compensation Act, Arizona Revised Statutes, Title 23, Chapter 6, authorizes the Commission to regulate fees for physical therapy services. Physical therapists may submit bills for services rendered to injured employees.
Q: Is the fee schedule applicable to an independent medical evaluation?
No. A provider may set their own fees for an independent medical evaluation. They may charge more or less than the fee schedule states a provider may charge for the same service.
Q: Can a provider negotiate their own fee schedule?
Yes, a healthcare provider may negotiate their own fee schedule for services. A healthcare provider and a payer may set their own rates by mutual agreement. If they are able to agree on a certain schedule of fees, they may both bill and collect payment according to that agreement rather than the Arizona fee schedule.
Q: Does the Industrial Commission of Arizona have a dispute resolution process?
No, it doesn’t. The Commission doesn’t get involved when providers and insurers disagree about billing practices. Instead, the parties must resolve the disagreement themselves or resort to dispute resolution.
Questions and answers about compensation for a job-related accident, injury or illness in Arizona
