reglab/statecodes huggingface dataset:
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 9 - FEE SCHEDULES › Section 9-2 - Fee Schedules

Current through July 13, 2024
(a) The
				Division adopts the most recent version published prior to the date of service
				for the following references
Geographically Adjusted Resource Based
				Relative Value Scale (RBRVS),
as published by Optum 360, LLC, as
				authored by the American Medical Association (AMA), insofar as it addresses
				medical matters under the Act unless otherwise defined in this chapter and, the
Relative Values for Dentists (RVD),
as published and authored
				by Relative Value Studies, Inc., Thornton, Colorado, insofar as it addresses
				dental matters under the Act.
(i) The Division
				has determined that incorporation of the full text in these rules would be
				cumbersome or inefficient given the length or nature of the rules;
(ii) The incorporation by reference does not
				include any later amendments or editions of the incorporated matter beyond the
				applicable date identified in subsection (a) of this section; and
(iii) The incorporated code, standard, rule
				or regulation is maintained at 5221 Yellow stone Road, Cheyenne, WY 82002 and
				is available for public inspection and copying at cost at the same
				location.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 9 - FEE SCHEDULES › Section 9-3 - Fees for Home Health Nursing

Current through July 13, 2024
(a) The
				Division adopts the following fee-based schedule guidelines for home health
				nursing services being provided by independent Medicare/Medicaid certified
				agencies. This is a straight fee, no overtime, holiday rate, or shift
				differential shall be paid and Fair Labor Standards Act (FSLA) exempt. A visit
				equals a range of fifteen (15) minutes to a maximum of four (4) hours per day.
				See Chapter 10, Section 17 and Chapter 9, Section 1 for additional guidelines.
Type of
						  Nursing
Per Visit
						  Rate
RN
$146.50
LPN
$146.50
CNA
$66.34
(b)
				The Division adopts the following fee-based schedule guidelines for Private
				duty services/attendant care. This fee schedule is for long term daily care at
				home and is Fair Labor Standards Act (FSLA) exempt. This is a straight hourly
				fee, no overtime, holiday rate or shift differential shall be paid. See Chapter
				10, and Chapter 9, Section 1 for additional guidelines.
Type of
						  Nursing
Hourly
						  Rate
RN
$35.00
LPN
$35.00
CNA
$16.00
*Attendant
*Federal minimum wage
*Attendant care includes personal care for activities of
				  daily living. A physician prescription and time limit is required. Attendant
				  care shall be provided by individuals approved by the primary treating health
				  care provider.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 9 - FEE SCHEDULES › Section 9-4 - Fees for Supplies, Implants, Durable Medical Equipment (DME), Orthotics and Prosthetics

Current through July 13, 2024
(a) The
				Division adopts the Non-Rural Wyoming Medicare rate plus thirty percent (+30%)
				of the Healthcare Common Procedure Coding System (HCPCS) as the rates were
				published as of January 1, of the year for the date of service submitted, for
				the payment of supplies, DME, orthotics and prosthetic devices prescribed by a
				health care provider. See Chapter 9, Section 1 for additional guidelines. The
				Division shall not pay for any supplies, DME, orthotics, or prosthetics unless
				prescribed by the treating health care provider. The Division will not include
				quarterly updates for these payments, the payments will remain consistent with
				the January 1, of the year for the date of service submitted published rates.
(i) The Division has determined that
				incorporation of the full text in these rules would be cumbersome or
				inefficient given the length or nature of the rules;
(ii) The incorporation by reference does not
				include any later amendments or editions of the incorporated matter beyond the
				applicable date identified in subsection a of this section; and
(iii) The incorporated code, standard, rule
				or regulation is maintained at 5221 Yellow stone Road, Cheyenne, WY 82002 and
				is available for public inspection and copying at cost at the same
				location.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 9 - FEE SCHEDULES › Section 9-5 - Fees for Hearing Aids/Prescription Lenses

Current through July 13, 2024
See Chapter 10, and Chapter 9, Section 1 for additional
				  guidelines.
(a) The Division shall pay
				130% of the supplier's/manufacturer's invoice price for hearing aids when the
				provider submits the invoice to the Division.
(b) The Division shall reimburse for frames
				and lenses as prescribed for compensable vision loss, or replacement due to a
				work-related accident, not to exceed 80% HCPCS usual and customary benchmarks
				as determined annually by the Division. The Division may demand additional
				documentation and justification for any charges deemed excessive by the
				Division.
(c) The Division shall
				reimburse an injured worker for the repair or comparable replacement of a
				hearing aid device or prescription lens damaged or destroyed in a work-related
				accident.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 9 - FEE SCHEDULES › Section 9-6 - Fees for Pharmacy Items

Current through July 13, 2024
Pharmaceuticals must be billed with a National Drug Code
				  (NDC) and the correct units for the NDC. See Chapter 10, and Chapter 9, Section
				  1 for additional guidelines.
(a)
				Pharmaceuticals shall be reimbursed at the lower of:
(i) Average Wholesale Price (AWP) minus 10%
				plus a $5.00 dispensing fee; or
(ii) The provider's usual and customary
				charge. In no case shall any provider bill for charges greater than those
				charged to the general public for like services. The Division reserves the
				right to review such charges and reimburse at the usual and customary rate if a
				discrepancy is found.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 9 - FEE SCHEDULES › Section 9-7 - Fees for Compounded Medications

Current through July 13, 2024
See Chapter 10, Section 7, and Chapter 9, Section 1 for
				  additional guidelines.
(a) Physicians
				billing for compounded drugs must provide the pharmacy invoice. The Division
				shall pay 130% of the supplier's/manufacturer's invoice price.
(b) Compounding pharmacies that bill
				directly, shall be compensated for the drugs prescribed and related materials
				in accordance with Chapter 9, Section 6. The Division shall allow a fee for
				compounding services. Compounding medications shall be reimbursed per line item
				if each ingredient is determined to be coverable per Chapter 10, Section 7,
				Compound Prescription Medications.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 9 - FEE SCHEDULES › Section 9-8 - Fees for Ambulance Services

Current through July 13, 2024
(a) Ambulance
				services shall be paid the lesser of the billed charge or the maximum allowable
				rate for the code appropriate for the documented service. The maximum allowable
				rates are all-inclusive. Mileage shall be reimbursed per documented loaded
				statute mile. See Chapter 9, Section 1 for additional guidelines
(b) The Division adopts CMS Rural Wyoming
				Medicare rates plus 30%, these rates can found at:
https://med.noridianmedicare.com/web/jfb/fees-news/fee-schedules/ambulance-fees
.
(c) Please contact the Division's Provider
				Service Unit for information regarding Air Ambulance reimbursement at: (307)
				777-7441.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 9 - FEE SCHEDULES › Section 9-9 - Facility Fees

Current through July 13, 2024
(a) Fees for
				Inpatient Hospital Services.
(i) Inpatient
				hospital services shall be reimbursed in accordance with the CMS IPPS
				(Inpatient Prospective Payment System) payment methodology. With the Wyoming
				Base Rate at 150% of Medicare; updated on July 1st
				of each year; and the MS-DRG (Medicare Severity-Diagnosis Related Group) weight
				according to the CMS Table 5 (for the corresponding year of service) found at:
https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2024-ipps-final-rule-home-page
.
(ii) Medical services for which there is no
				inpatient weight listed shall be reimbursed at eighty percent (80%) of the
				reasonable charge.
(iii) If the
				inpatient admission and discharge occurs across different calendar years, the
				Base Rate and MS-DRG weight of the admission year shall be used for the
				entirety of the inpatient stay.
(iv) Required documentation to support billed
				charges are as follows:
(A) Detailed
				itemization;
(B) Anesthesia
				graphic;
(C) Operative
				report;
(D) History and
				physical;
(E) Discharge
				summary;
(F) Implant Log and
				itemization; and
(G) Supplier's
				invoice for any supplies and/or implants charged at five thousand dollars
				($5,000.00) or more, per episode of care, for device intensive procedures as
				indicated by Medicare. Such items shall be reimbursed at one hundred fifteen
				percent (115%) of invoice amount. Shipping and handling charges shall not be
				reimbursed.
(v) Bills
				shall be audited for unidentified and unrelated services and/or
				items.
(vi) The Division shall
				provide a copy of the audit upon request.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 9 - FEE SCHEDULES › Section 9-10 - Fees for Home Infusion Therapy

Current through July 13, 2024
(a) Home
				Infusion Therapy will be paid in accordance with the Wyoming Medicare Home
				Infusion Therapy Fees, for the year of service submitted, plus a thirty percent
				(30%) increase.
(b) The Division
				shall pay only one of the G-codes per line item date of service when one of the
				drugs from the applicable category is billed with the same line item date of
				service or a date of service within thirty (30) days prior to the G-code visit.
(i) Healthcare Common Procedure Coding System
				(HCPCS) code S9328-Home Infusion Therapy, implanted pump pain management
				infusion; administrative services, professional pharmacy services, care
				coordination, and all necessary supplies and equipment (drugs and nursing
				visits coded separately), per diem will be paid at Workers' Compensation Usual
				and Customary fee of two hundred dollars ($200.00).
(ii) The fees associated with the G-codes on
				the MPFSD fee file will be "a per day rate"; therefore, the units on the line
				should not be multiplied by the rate.
(iii) The drug remains separately payable
				from the G-code line item Home Infusion Therapy suppliers will report the
				following HCPCS G-codes associated with the payment categories for the
				professional services furnished in the individual's home and on an infusion
				drug administration calendar day.
(iv) For additional information regarding the
				Medicare rates and coding for these services, please visit:
https://www.cms.gov/files/document/se19029.pdf
and
https://med.noridianmedicare.com/web/jfb/fees-news/fee-schedules/home-infusion-therapy-fees
.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-1 - Acupuncture

Current through July 13, 2024
(a) The Division
				shall pay for acupuncture procedures only if the services are performed by a
				healthcare provider as defined in W.S. §
									27-14-102(a)(x),
				who is certified to perform acupuncture. Before the Division will issue any
				payment for acupuncture services, the health care provider shall submit to the
				Division proof of certification in acupuncture from an accredited school or a
				school that is a candidate for accreditation.
(i) The Division shall pay for acupuncture
				procedures performed by Acupuncturists who have been issued a license to
				practice acupuncture by the Wyoming Board of Acupuncture. The Division will
				only consider payment to a fully licensed Acupuncturist upon receipt of written
				orders from the injured worker's treating health care provider specifying the
				diagnosis and number of sessions or timeframe. To verify licensure go to:
http://acupuncture.wyo.gov
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-2 - Alcohol and Drug Testing Protocols

Current through July 13, 2024
(a) Nothing in this
				rule is intended to authorize any employer to test any employee for alcohol or
				drugs in any manner inconsistent with constitutional, federal or statutory
				requirement.
(b) Nothing in this
				rule shall be construed to require an employer to test, or create a legal
				obligation upon the employer to request an employee to undergo drug or alcohol
				testing. An employer's decision to post-accident test should be consistent with
				their substance abuse and testing policy.
(c) All drug and alcohol testing, initial and
				confirmation, conducted in conjunction with the employer's drug-free workplace
				policy will be at the employer's expense.
(i)
				All testing for alcohol and controlled substances will be conducted in
				accordance with the requirements of 49 CFR Part 40, which procedures are
				designed to protect the employee and the integrity of the testing process,
				safeguard the validity of the test results, and ensure those results are
				attributed to the correct employee.
(ii) Pursuant to 49 CFR Part 40, a covered
				employer may test for any and all metabolites: including synthetic forms of:
				Amphetamines; Marijuana (cannabinoids); Cocaine (benzoylecgonine); Opiates
				(codeine, morphine, heroin); PCP (phencyclidine); Alcohol; or any controlled
				substance subsequently subject to testing pursuant to drug testing regulations
				adopted by the United States Department of Transportation.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-3 - Alternative Medicine

Current through July 13, 2024
Except as provided in Section
				  10 of this Chapter, the Division will not
				  authorize or pay for any alternative medicine treatments, defined as any
				  medical practice or intervention that lacks sufficient documentation for safety
				  or effectiveness against any specific conditions, or lacks a valid scientific
				  base.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-4 - Biofeedback

Current through July 13, 2024
Biofeedback services shall be paid according to Chapter 9,
				  Section 2 of these rules. The
				  following conditions apply:
(a)
				Individual meets the definition of "injury" under W.S. §
									27-14-102(a)(xi);
				and,
(b) The services must be
				prescribed by the primary treating health care provider.
(c) Administration of biofeedback treatment
				is limited to those practitioners who are certified by the Biofeedback
				Certification Institute of America;
(d) Practitioners must submit a current copy
				of their biofeedback certification to the Division of Workers'
				Compensation;
(e) Treatment can be
				authorized when the following is presented to the Division:
(i) An evaluation report documenting:
(A) The basis for the injured worker's
				condition;
(B) The condition's
				relationship to the work injury;
(C) An evaluation of the injured worker's
				functional measurable modalities (e.g., range of motion, uptime, walking
				tolerance, medication intake, etc.);
(D) An outline of the proposed treatment
				program; and,
(E) An outline of the
				expected restoration goals.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-5 - Biological or Chemical Exposure Injury

Current through July 13, 2024
The Division shall pay for the laboratory testing of any
				  specimen collected from the body of an injured worker in order to determine his
				  exposure to biological or chemical agents in covered employment, if such tests
				  are ordered by the treating health care provider.
(a) If medical emergency response personnel
				determine that an injured worker should be treated in a hospital emergency
				room, the Division will pay for ambulance transportation from the place of
				exposure to the nearest hospital.
(b) The Division shall pay for
				hospitalization of the injured worker, subsequent to his receipt of treatment
				in an emergency room, if it is determined by the treating physician that
				in-patient confinement is necessary to establish the existence and extent of
				exposure, and to diagnose the effects of the exposure.
(i) Except to the extent expressly provided,
				nothing in this section shall relieve a worker of the burden to prove the
				elements of an "injury" as defined by W.S. §
										27-14-102(a)(xi).
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-6 - Blood-borne Pathogen Testing and Prophylactic Care

Current through July 13, 2024
(a) Benefits for
				human blood-borne pathogen testing and prophylactic care under W.S. §
									27-14-501(a)
				shall be limited to the cost of reasonable and necessary initial and follow-up
				testing and reasonable and necessary prophylactic treatment. Benefits under
				this section shall be available only to workers reasonably believed to have
				incurred a potentially significant exposure.
(b) Nothing in this section shall limit
				benefits for testing and prophylactic care to any particular covered
				occupations included in the definition of "injury" under W.S. §
									27-14-102(a)(xi)
				and prescribing reasonable prophylactic medical treatment during the disease's
				latency period.
(c) Except to the
				extent expressly provided, nothing in this section shall receive a worker of
				the burden to prove the elements of an "injury" as defined by W.S. §
									27-14-102(a)(xi).
(d) Nothing in this subsection shall limit
				benefits for an exposure to a disease that has resulted in an "injury" as
				defined in W.S. §
									27-14-102(a)(xi)
(e) The Division will follow current
				recommendations of the Centers for Disease Control and Prevention for
				post-exposure prophylaxis.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-7 - Compound Prescription Medications

Current through July 13, 2024
The Division shall pay for compound prescription medications
				  per Wyoming Worker' Compensation formulary listed at:
https://dws.wyo.gov/dws-division/workers-compensation/resources-information/provider-bulletins/
,
				  National Drug Code (NDC) and the fee schedule listed in Chapter 9, Section
				  7 of these rules.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-8 - Durable Medical Equipment (DME)

Current through July 13, 2024
The limitations in this section are in addition to any other
				  limitation or restrictions that may apply to the Division's rental or purchase
				  of any physical items or apparatus as a benefit under the Act.
(a) The Division will not rent or purchase or
				provide reimbursement for any physical item or apparatus for use by an injured
				worker unless there is proof that the item:
(i) Is medically necessary for the documented
				compensable work injury;
(ii) Is
				prescribed by a health care provider;
(iii) Is the most cost-effective method of
				meeting the medical need;
(iv) Has
				primary purpose other than enhancing the personal comfort of the injured worker
				or providing convenience for the injured worker or caregiver;
(v) Is designed to withstand repeated use in
				the home;
(vi) Generally is not
				useful to a person in the absence of an illness or injury;
(vii) Has primary purpose other than
				enhancing the personal comfort of the injured worker or providing convenience
				for the injured worker or caregiver;
(viii) Is the type of item that is suitable
				and commonly provided for home use or mobility under employer provided health
				insurance coverage, Medicare or Medicaid; and,
(ix) Generally has an expected lifetime of at
				least three (3) years.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-9 - Emergency or After Office Hours Care

Current through July 13, 2024
Emergency or necessary after office hours care performed in a
				  non-emergency room setting shall be coded 99050. This code shall be paid in
				  addition to other services provided during the same visit. Emergency department
				  services shall be billed using the appropriate CPT codes.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-10 - Experimental Care

Current through July 13, 2024
Experimental care is defined as any device, drug, procedure
				  or test used in the delivery of medical, pharmaceutical, surgical or
				  therapeutic services that are not customary and considered investigational,
				  unusual, controversial and/or obsolete. The Division will neither authorize nor
				  pay for these services.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-11 - Functional Capacity Evaluation

Current through July 13, 2024
A functional capacity evaluation can be requested by the
				  Division, the health care provider, or the employer to measure general residual
				  functional capacity to perform work or provide other general evaluation
				  information, including musculoskeletal evaluation. The functional capacity
				  evaluation must be performed by a licensed physical therapist or occupational
				  therapist credentialed or experienced in performing functional capacity
				  evaluations. The functional capacity evaluation must have objective components
				  which measure the validity of the test results.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-12 - Hearing Aids

Current through July 13, 2024
If it has been determined through medical examination and
				  testing that an injured worker incurred a hearing impairment as a result of a
				  compensable injury, the Division shall pay for examinations and testing of the
				  ear(s), and the purchase of hearing aid devices(s) approved by the Food and
				  Drug Administration (FDA), and respective supplies, in order to restore the
				  injured worker's hearing as close to pre-injury status as possible.
(a) A hearing test must be performed, and the
				results submitted to the Division, in order to substantiate the existence of a
				compensable hearing loss and to establish a base line from which to measure any
				potential increase in hearing impairment in the future.
(b) The Division shall pay for a replacement
				hearing aid only if the treating physician submits a written report to the
				Division, specifying that a new hearing aid is required due to an increase in
				hearing impairment which is directly related to the compensable injury. The
				report must include the results of a current hearing test, which evidences an
				increase in hearing impairment over the base line, or the results of the last
				hearing test on file with the Division.
(c) If the Division verifies that an injured
				worker's pre-existing hearing aid, not his hearing, was damaged or destroyed as
				a result of a work-related accident, the Division shall pay for one comparable
				replacement hearing aid.
(i) The Division will
				not pay for a cochlear implant, tympanoplasty, or other similar surgery as a
				replacement for a damaged or destroyed hearing aid device.
(ii) The Division will not pay for a
				subsequent replacement hearing aid if the first replacement hearing aid was
				lost, stolen, or broken.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-13 - Home and Vehicle Modifications

Current through July 13, 2024
(a) Workers who
				have experienced a catastrophic injury may be eligible for home and vehicle
				modifications. Catastrophic injuries include, but are not limited to paralysis,
				quadriplegia, severe head trauma, amputation and multiple traumas. Requests for
				home or vehicle modifications will be reviewed by Division staff to determine
				if the home or vehicle modification meets the injured worker's needs for
				safety, mobility, and activities of daily living. Only one residence and one
				current vehicle of a catastrophically injured worker will be modified.
				Modifications must be reasonable and appropriate for the injured worker's
				actual functional disability and level of care.
(i) A home modification is defined as a
				physical structural change to an injured worker's permanent residence. If the
				injured worker does not own property of his residence, he must obtain and
				submit to the Division written permission for structural modification and proof
				of ownership from the property owner before modifications will be considered.
(A) The Division will not pay for any
				structural modifications performed prior to the Division giving written
				consent.
(B) The Division will not
				pay to restore the modified structure to its original condition when the
				injured worker ceases to reside on the property.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-14 - Impairment Ratings-Requirements

Current through July 13, 2024
(a) Pursuant to
				W.S. §
									27-14-405(g) any
				physician determining permanent physical impairment shall:
(i) Have a current, active, and unrestricted
				license to practice medicine issued by a state medical board; and,
(ii) Use the instructions and complete all
				required measurements referencing all tables contained in the
American
				Medical Association's Guide to the Evaluation of Permanent Impairment.
The Division requires impairment ratings to be submitted in the same format as
				the forms contained within that publication.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-15 - Independent Medical Evaluation

Current through July 13, 2024
The Division may require an injured worker to submit to an
				  Independent Medical Evaluation by a non-treating health care provider for the
				  purpose of obtaining a second opinion regarding the diagnosis, prognosis or
				  treatment of an injured worker's injury complaints, or to obtain a permanent
				  partial impairment rating of the residual effects attributed to a compensable
				  injury per W.S. §
									27-14-401(f). The
				  evaluation may include: review of medical records, diagnostic studies, or other
				  relevant materials; examination of the injured worker; consultations with other
				  health care providers or Division representatives; and, any technical
				  preparation by office staff.
(a) The
				Division may request a non-treating health care provider to conduct a paper
				review of an injured worker's medical records for the purpose of obtaining a
				second opinion regarding the diagnosis, prognosis, or treatment of an injured
				worker's injury complaints. When conducting a paper review, the health care
				provider conducting the review will be paid at the same rate as a physician who
				performed an Independent Medical Evaluation for the Division.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-16 - Massage Therapy

Current through July 13, 2024
Massage therapy treatment will be permitted when given by a
				  massage practitioner upon written orders from the injured worker's treating
				  health care provider. Massage therapy treatment must be under the direct
				  supervision of a healthcare provider as defined in W.S. §
									27-14-102(a)(x)
				  and it is in conjunction with other therapy modalities.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-17 - Nursing Services

Current through July 13, 2024
No fee under this section shall be allowed by the Division
				  without first reviewing the fee for appropriateness and reasonableness in
				  accordance with its adopted fee schedules.
(a) Home Health Nursing Services
(i) Home Health Nursing Services shall be
				intermittent, medically necessary, related to the work injury, documented in a
				plan of treatment, expected to last six (6) months or less, and ordered by a
				physician.
(ii) Initial
				prescriptions/orders for home health nursing services shall include the reason
				for home health skilled nursing, frequency, and duration.
(iii) Face to face visit. All new home health
				orders shall be accompanied by documentation of a face to face visit having
				occurred within ninety (90) days prior to the start of home health
				services.
(iv) Only independent
				Medicare/Medicaid certified agencies may provide home health nursing
				care;
(v) Only Certified Nursing
				Assistants, Licensed Practical Nurses, Licensed Vocational Nurses or Registered
				Nurses working for a Medicare/Medicaid certified agency can provide home health
				nursing care;
(vi) If the injured
				worker's residence is not within a fifty (50) mile radius of a
				Medicare/Medicaid certified agency, the Division may approve other alternatives
				such as Private Duty Nursing Services. Any such arrangement must have prior
				approval from the Division.
(vii)
				Home Health Nursing Services beyond six (6) consecutive months shall be
				reviewed by the Division to determine continued medical necessity.
(viii) Private Duty Services/Attendant Care.
				Private duty services/attendant care for long term daily care at home not being
				provided by a Home Health Agency, includes but not limited to; personal care
				for activities of daily living.
(ix) Initial prescriptions/orders for
				services shall include the reason for private duty services/attendant care,
				frequency, and duration.
(x)
				Private duty services/attendant care shall be provided by individuals who are
				approved by the primary treating health care provider.
(xi) Private duty services/attendant care
				shall be paid for a maximum of twelve (12) hours per day per
				provider.
(xii) Private duty
				services/attendant care required beyond twelve (12) consecutive months shall be
				reviewed by the Division; every twelve (12) months thereafter to determine
				continued medical necessity.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-18 - Nutritional Supplements

Current through July 13, 2024
The Division shall reimburse nutritional supplements,
				  vitamins, and non-prescription drugs recommended by the treating health care
				  provider, only if FDA approved and the supporting medical records document
				  severe clinical dietary problems attributed to the compensable injury.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-19 - Off-label use of Medical Services

Current through July 13, 2024
Medications, treatments, procedures or other medical services
				  used for other than the approved Food and Drug Administration (FDA)
				  indications. These services should be medically necessary, i.e., have a
				  reasonable expectation of cure or significant relief of a condition consistent
				  with any applicable treatment parameter (Rules and Regulations Chapter 1,
				  Section 3, Subsection (gg)).
				  The health care provider must document in the medical record the off-label use
				  is medically necessary, and will submit to the Division a comprehensive review
				  of the medical literature. This review will include at least two (2) reliable
				  prospective, randomized, placebo-controlled, double-blind trial. The Division
				  will consider the quality of the evidence and determine medical
				  necessity.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-20 - Payment for Medical Services and Professional Fees

Current through July 13, 2024
(a) Claims for
				medical services provided to an injured worker for a compensable injury, and
				any associated fees charged by professionals, will be denied if: they fail to
				comply with the following standards for content of medical records:
(i) If handwritten, medical notes must be
				legible to anyone reading them,
(ii) If handwritten notes are illegible,
				medical notes must be typewritten,
(iii) Medical notes must include date of
				patient visit,
(iv) Medical notes
				must specify the reason for the encounter/visit and be described using the
				injured worker's own words,
(v)
				Medical notes must include a history and physical exam focused relative to
				injured worker's complaint to include a description of the findings of the
				examine relating to the reason for the complaint,
(vi) Medical notes must specify the diagnosis
				relative to the injured worker presenting complaint,
(vii) Medical notes must delineate a course
				of treatment consistent with the diagnosis,
(viii) The studies ordered of the injured
				worker must pertain to the complaint being addressed,
(ix) Medical notes must delineate the
				education instruction to the injured worker,
(x) Medical notes must contain an indication
				of the specifics of the follow-up care plan and include return-to-work
				expectations.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-21 - Physical Medicine and Restorative Services

Current through July 13, 2024
(a) Chiropractors,
				physical therapists, physical therapist assistants, occupational therapists,
				and occupational therapist assistants may perform treatment modalities in the
				management of soft tissue injuries for the progressive development of strength
				and mobility, and to improve functional outcomes. An initial evaluation should
				document the diagnosis or clinical impression consistent with presenting
				complaint(s) and the results of the examination and diagnostic procedures
				conducted. Subsequent visits performed require documentation of measured,
				objective, significant findings.
(b) The Division shall pay physical therapy
				and occupational therapy services only if they are provided pursuant to a
				prescription from the injured worker's primary treating health care provider,
				as defined in Chapter 1, Section
				3(mm) of these
				Rules.
(c) The Division shall
				monitor claims for services and may require provider to submit a formal written
				treatment plan or supplemental report detailing the medical necessity, specific
				goals, number of sessions and timeframes for review and authorization to
				continue the service. If the injured worker is not responding within the
				recommended duration periods, per the assessment of the provider, other
				treatment interventions, further diagnostics studies or consultation may be
				considered.
(d) The Administrator
				adopts the
Rehabilitation Therapy Utilization Guidelines for the Care
				and Treatment of Injured Workers
and
Chiropractic Utilization
				Guidelines for the Care and Treatment of Injured Workers
, which will
				be used by the Division in its evaluation and payment of physical therapy and
				chiropractic claims. These guidelines are available at:
https://dws.wyo.gov/dws-division/workers-compensation/resources-information/treatment-guidelines/
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-22 - Podiatry Treatment

Current through July 13, 2024
Fees for services of a podiatrist will be limited to those
				  allowed for minor surgery under the General Surgery section of the Locality
				  Specific Resource Based Value Scale (RBRVS), as adopted in Chapter 9, Section
				  2 of these Rules.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-23 - Preauthorization

Current through July 13, 2024
The Division pursuant to its rules and regulations may issue
				  a determination of preauthorization for an injured worker's nonemergency
				  hospitalization, surgery or other specific medical care. W.S. §
									27-14-601(o) as
				  amended.
(a) Treatment rendered by a
				health care provider to a Wyoming Workers' Compensation injured worker for
				injuries, will be professionally reviewed and preauthorized on issues of
				whether proposed treatment is reasonable, medically necessary and in compliance
				with the Division's rules, regulations and treatment guidelines. Such treatment
				guidelines shall be predicated on relevant medical literature consistent with
				evidence-based medicine, or insurance industry standards or practices, or the
				guidance of the Medical Commission, and shall be available upon request. Policy
				establishing treatment guidelines shall be available in written format and also
				maintained on the Division's internet website located at:
https://dws.wyo.gov/dws-division/workers-compensation/resources-information/preauthorization/
(b) The Division will institute procedures of
				preauthorization and utilization review. Policy outlining the description,
				medical definitions, and a required list of treatments to be preauthorized
				shall be developed, implemented and maintained.
(c) The Division will inform health care
				providers when treatment guidelines are expanded or modified, or there are
				changes in the Division policy or procedures.
(d) The preauthorization process
(i) Health care provider notification to the
				Division
(A) The health care provider must
				complete the request for preauthorization review form in writing, in advance of
				the injured worker receiving treatment for hospitalizations, surgeries or
				health care requiring preauthorization and submit it to the Division by fax,
				mail or email. The Provider Request for Preauthorization form can be obtained
				from the Division or through the internet at:
https://dws.wyo.gov/dws-division/workers-compensation/resources-information/preauthorization/
(B) Concurrent with submission of the
				Provider Request for Preauthorization, the health care provider must supply
				relevant clinical information. This will include chart notes that document the
				injured worker's history, physical examination findings, diagnostic test
				results, treatment plan, and prognosis.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-24 - Pregnancy Tests

Current through July 13, 2024
The Division shall pay for pregnancy test only if it is
				  ordered by an injured worker's treating health care provider to rule out
				  pregnancy prior to performing a procedure or treatment considered potentially
				  harmful to a fetus.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-25 - Prescribed Drugs and Pharmacy Services

Current through July 13, 2024
(a) The Division
				shall pay for prescription and over-the-counter medications only if a
				prescription, written by the treating provider is valid at the time of
				service.
(b) When medications
				prescribed for a compensable injury are dispensed on an outpatient basis, the
				Division will cover a brand name drug with an AB rated generic equivalent only
				if there is a documented medical necessity of the brand name. Prior
				authorization may be required for a brand name drug with an AB rated generic
				equivalent with the exception of certain drugs to be determined by the
				Division, to include specific anticonvulsant medications. The prescribing
				physician must provide the Division with medical justification for brand name
				medications, excluding anticonvulsants prescribed specifically for seizure
				control secondary to work injury.
(c) Healthcare providers directly dispensing
				prescriptions will be paid based on the original manufacturer's NDC code and
				the Wyoming Fee Schedule for pharmaceuticals as set forth in the
Rules
				Wyo. Dep't of Workforce Servs., Workers' Com. Div, Ch 9,
§
6.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-26 - Prescription Lenses

Current through July 13, 2024
If it has been determined through medical examination and
				  testing that an injured worker incurred a visual impairment as a result of a
				  compensable injury, the Division shall pay for examinations and testing of the
				  eye(s), and the purchase of prescription lenses to restore the injured worker's
				  vision as close to pre-injury status as possible.
(a) A vision test must be performed, and the
				results submitted to the Division, in order to substantiate the existence of a
				compensable vision loss and to establish a baseline from which to measure any
				potential increase in visual impairment in the future.
(b) The Division shall pay for the
				replacement of prescription lenses only if the treating physician,
				ophthalmologist, or optometrist submits a written report to the Division which
				specifies that the new lenses are required due to an increase in visual
				impairment which is directly related to the compensable injury. The report must
				include the results of the current eye examination, which results in an
				increase in visual impairment over the baseline, or the results of the last eye
				examination on file with the Division.
(c) If the Division verifies that an injured
				worker's prescription lenses and/or frames, not his vision, were damaged or
				destroyed as a result of a work-related accident, the Division shall only pay
				for one replacement of prescription lenses and/or frames associated examination
				costs.
(i) The Division will not pay for
				cosmetic refractive procedures, or other laser type surgery as a replacement
				for damaged or destroyed prescription lenses.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-27 - Smoking Cessation

Current through July 13, 2024
(a) Tobacco
				cessation products, including varenicline (Chantix), nicotine patches, gum and
				lozenges, and bupropion (generic Zyban), will be covered for appropriate
				injured workers undergoing a surgical procedure (including spinal fusion
				surgery), suffering from an orthopedic fracture or break, or with a wound in
				which healing may be negatively affected by smoking.
(b) A maximum coverage period of six (6)
				months will be approved for designated therapies.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-28 - Special Agreements

Current through July 13, 2024
The Division may enter into special agreements for services
				  provided by, or under the direction of, licensed providers authorized to treat
				  Wyoming injured workers. Special agreements may be made for services not
				  covered under the fee schedules adopted by the Division, and may include
				  multi-disciplinary or interdisciplinary programs, pain management, work
				  hardening, and physical conditioning, rehabilitation programs, and long-term
				  nursing care. The Division shall establish payment rates for special agreements
				  based on individual cases and may establish outcome criteria, measures of
				  effectiveness, minimum staffing levels, certification requirements, special
				  reporting requirements, and other criteria to ensure injured workers receive
				  good quality and effective services at a reasonable cost. The Division may
				  terminate special agreements and programs upon 30 days written notice to the
				  provider.
Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0021 - Workers' Compensation Division › Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS › Section 10-29 - Therapeutic Injections

Current through July 13, 2024
Therapeutic injections such as trigger point injections,
				  facet joint injections, facet nerve blocks, sympathetic nerve blocks,
				  epidurals, nerve root blocks, and peripheral nerve blocks shall be compensable
				  only if administered to anatomical sites where they are reasonably calculated
				  to treat the compensable injury. Prior to the first injection, the health care
				  provider shall document in the injured worker's medical record the medical
				  necessity for the injections, other active modalities, and instructions for the
				  injured worker's home exercise plan. If additional injections are indicated,
				  the prescribing health care provider shall provide subsequent documentation
				  indicating the medical necessity and continued need for service in the injured
				  worker's medical record. Payment for injections shall be based upon the
				  appropriate CPT code. The Division will not pay for injections beyond a period
				  of six (6) consecutive months unless the health care provider certifies the
				  medical necessity and need for additional injections in the injured worker's
				  medical record.