Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 15 - WORKERS COMPENSATION MEDICAL FEE SCHEDULE & EXHIBIT A › Subchapter 4 - ADMINISTRATION › Section 12-15-90 - Workers' compensation medical fee schedule

Current through
				June, 2024
(a) Charges
				for medical services shall not exceed one hundred ten per cent of participating
				fees prescribed in the Medicare Resource Based Relative Value Scale System fee
				schedule (Medicare Fee Schedule) applicable to Hawaii or listed in exhibit A,
				located at the end of this chapter and made a part of this chapter, entitled
				"Workers' Compensation Supplemental Medical Fee Schedule", dated January 1,
				2018. The Medicare Fee Schedule in effect on January 1, 1995 shall be
				applicable through June 30, 1996. Beginning July 1, 1996 and each calendar year
				thereafter, the Medicare Fee Schedule in effect as of January 1 of that year
				shall be the effective fee schedule for that calendar year.
(b) If maximum allowable fees for medical
				services are listed in both the Medicare Fee Schedule and the Workers'
				Compensation Supplemental Medical Fee Schedule, dated January 1, 2018, located
				at the end of this chapter as exhibit A, charges shall not exceed the maximum
				allowable fees allowed under the Workers' Compensation Supplemental Medical Fee
				Schedule, dated January 1, 2018, located at the end of this chapter as exhibit
				A.
(c) If the charges are not
				listed in the Medicare Fee Schedule or in the Workers' Compensation
				Supplemental Medical Fee Schedule, dated January 1, 2018, located at the end of
				this chapter as exhibit A, the provider of service shall charge a fee not to
				exceed the lowest fee received by the provider of service for the same service
				rendered to private patients. Upon request by the director or the employer, a
				provider of service shall submit a statement to the requesting party, itemizing
				the lowest fee received for the same health care, services, and supplies
				furnished to any private patient during the one-year period preceding the date
				of a particular charge. Requests shall be submitted in writing within twenty
				calendar days of receipt of a questionable charge. The provider of service
				shall reply in writing within thirty-one calendar days of receipt of the
				request. Failure to comply with the request of the employer or the director
				shall be reason for the employer or the director to deny payment.
(d) Fees listed in the Medicare Fee Schedule
				shall be subject to the current Medicare Fee Schedule bundling and global rules
				if not specifically addressed in these rules. The Health Care Financing
				Administration Common Procedure Coding System (HCPCS) alphabet codes adopted by
				Medicare will not be allowed, except for injections and durable medical
				equipment, unless specifically adopted by the director. The director may defer
				to a fee listed in the Medicare HCPCS Fee Schedule when a fee is not listed in
				the Workers' Compensation Supplemental Medical Fee Schedule, Exhibit
				A.
(e) Providers of service will be
				allowed to add the applicable Hawaii general excise tax to their
				billing.