7 Colo. Code Regs. § 1101-3-18-7
Before a meeting is separately payable, the following requirements must be met:
DoWC Z0601, $76.99 per 15 minutes billed to the requesting party.
DoWC Z0602, $76.99 per 15 minutes billed to the requesting party.
The Payer shall pay one-half of the usual fee for the scheduled services, or $187.27, whichever is less:
DoWC Z0720. The provider shall indicate the code corresponding to the service that has been cancelled in Box 19 of the CMS-1500 form or electronic billing equivalent.
For Payer-made appointments scheduled for four hours or longer, the Payer shall pay one-half of the usual fee for the scheduled service.
DoWC Z0740. The Provider shall indicate the code corresponding to the service that has been cancelled in Box 19 of the CMS-1500 form or electronic billing equivalent.
When an injured worker fails to keep a scheduled appointment, the Provider should contact the Payer within five days. Upon reporting the missed appointment, the Provider may inquire if the Payer wishes to reschedule the appointment for the injured worker. If the injured worker fails to keep the Payer's rescheduled appointment, the Provider may bill for a cancellation fee according to this section.
The Payer, Payer's representative, injured worker, and injured worker's representative shall pay a reasonable fee for the reproduction of the injured worker's medical record. Copying charges do not apply for the initial submission of records that are part of the required documentation for billing. If records are readily producible electronically and appropriate security is in place, including but not limited to compatible encryption, the provider shall provide the requestor with an electronic copy (e.g., email). If the requester and Provider agree, the copy may be provided by fax, on paper, or by disc. Provider may not charge a fee for a records search and retrieval. All records shall be provided no later than 30 days from the date the request is received.
Copying Fee Billing Codes and Maximum Fees:
DoWC Z0721, $18.53 for first 10 or fewer paper page(s), including faxed documents
DoWC Z0725, $0.85 per paper page for the next 11-40 paper page(s), including faxed documents
DoWC Z0726, $0.57 per paper page for remaining paper page(s), including faxed documents
DoWC Z0727, $1.50 per microfilm page
DoWC Z0728, $14.00 per computer disc
DoWC Z0729, $6.50 per electronic copy
DoWC Z0802, actual postage paid
If a party shows good cause to an Administrative Law Judge (ALJ) for exceeding the Medical Fee Schedule allowance, that ALJ may allow a greater fee.
By prior agreement, the Provider may charge for preparation time for a deposition or testimony, for reviewing and signing the deposition, or for preparation time for testimony.
Treating or non-treating Physician or Psychologist:
DoWC Z0730, $190.74, billed in half-hour increments. Other Providers are allowed 85% of this fee.
Payment for testimony at a deposition shall not exceed $190.74, billed in half-hour increments, for a treating or non-treating Physician or a Psychologist. DoWC Z0734, calculating the Provider's time from "portal to portal." Other Providers are allowed 85% of this fee.
If requested, the Provider is entitled to a full hour deposit in advance in order to schedule the deposition.
If the Provider is notified of the cancellation of the deposition at least ten days prior to the scheduled deposition, the Provider shall be paid the number of hours that have been reasonably spent in preparation, less any deposit paid by the deposing party. DoWC Z0731, $190.74, in half-hour increments.
If the Provider is notified less than ten days in advance of a cancellation or rescheduling, or the deposition is shorter than the time scheduled, the Provider shall be paid the number of hours that have been reasonably spent in preparation and have been scheduled for the deposition. DoWC Z0733, $190.74, in half-hour increments.
Treating or non-treating Physician or Psychologist:
DoWC Z0738, $264.18, billed in half-hour increments. Other Providers are allowed 85% of this fee.
Calculation of the Provider's time shall be "portal to portal" (includes travel time and mileage in both directions).
For testifying at a hearing, if requested, the Provider is entitled to a four-hour deposit in advance in order to schedule the testimony.
If the Provider is notified of the cancellation of the testimony at least ten days prior to the scheduled testimony, the Provider shall be paid the number of hours that have been reasonably spent in preparation, less any deposit paid by the requesting party. DoWC Z0735, $264.18, in half-hour increments.
If the Provider is notified less than ten days in advance of a cancellation or rescheduling, or the testimony is shorter than the time scheduled, the Provider shall be paid the number of hours that have been reasonably spent in preparation and has scheduled for the testimony. DoWC Z0737, $264.18, in half-hour increments.
The Payer shall advance or reimburse the injured worker for reasonable and necessary mileage expenses for travel to and from medical appointments. The injured worker shall submit a request to the Payer showing the date(s) of travel and mileage, incurred or anticipated, and explain any other reasonable and necessary travel expenses. The number of miles shall be in whole numbers and calculated using the most direct route available on the date of service. Advance mileage is available for eligible travel greater than 100 miles round trip, and shall be approved when requested by the injured worker at least seven days in advance.
Mileage Pre-paid Expense: | DoWC Z0722, 59 cents per mile |
Mileage Expense: | DoWC Z0723, 59 cents per mile |
Other Travel Expenses: | DoWC Z0724, actual paid |
The Physician determining the permanent impairment rating must be Level II accredited and comply with Rule 5 as applicable.
If a Physician determines the injured worker is at MMI and has no permanent impairment, the Physician should be reimbursed for the examination at the appropriate level of E&M service. The ATP managing the total workers' compensation claim should complete the Physician's Report of Workers' Compensation Injury (Closing Report), WC 164 (see section 18-7(G)(2)).
Extensive medical records take longer than one hour to review and require a separate report. The separate report must document each record reviewed, specific details of the records reviewed, and the dates represented by the records reviewed. The separate record review can be billed as a special report and requires prior authorization.
All Physicians and Psychologists (including Level II Accredited Physicians) providing consulting services for the completion of a whole person impairment rating shall bill using the appropriate E&M consultation code, or psychological diagnostic evaluation code, and shall forward their portion of the rating to the Physician determining the combined whole person rating.
A return visit for a range of motion (ROM) validation shall be billed with the appropriate code in the Medicine Section of CPT®.
The date the Physician sees the injured worker shall be the date of service billed.
DoWC Z0759, $612.00, for the Level II Accredited Authorized Treating Physician providing primary care.
DoWC Z0760, $822.12, for the Referral, Level II Accredited Authorized Physician (the claimant is not a previously established patient to that physician for that workers' compensation injury).
DoWC Z0764, If the injured worker fails to attend the impairment rating appointment or if the parties notify the Physician of a cancellation or rescheduling five days or less prior to the appointment, the Physician shall be paid one-half of the fee for the scheduled service. The Physician shall indicate the code corresponding to the scheduled service in Box 19 of the CMS-1500 form or electronic billing equivalent.
Providers shall submit routine reports free of charge as directed in Rule 16 and by statute. Requests for additional copies of routine reports and for reports not in Rule 16 or statute are reimbursable under the copying fee section of this Rule. Routine reports include:
The ATP and ED/urgent care physician, when applicable, shall complete the first report of injury. Items 1-7 and 11 must be complete. However, item 2 may be omitted if not known by the Provider. If completed by a PA or NP, the ATP must countersign the form.
DoWC Z0750 Initial Report | $51.00 |
The ATP managing the workers' compensation claim must complete the WC 164 closing report when the injured worker is at maximum medical improvement (MMI) for all covered injuries or diseases, with or without a permanent impairment. Items 1-5, 6 B-C, 7 (if applicable), and 8-11 must be complete. If completed by a PA or NP, the ATP must countersign the form.
DoWC Z0752 Closing Report | $51.00 |
If the injured worker has sustained a permanent impairment, the following additional information must be attached to the bill when MMI is determined:
DoWC Z0753 | $51.00 |
Any request from the Payer or the employer for the information provided on this form is deemed authorization for payment. The Provider shall document the name of the person who made the request and the date of the request on the WC 164; complete items 1, 2, 4-7, and 11; and send it to all parties within five days of the request. If completed by a PA or NP, the ATP must countersign the form.
DoWC Z0751 | Progress Report | $51.00 |
The requesting party shall pay for its request for a physician to complete additional forms requiring 15 minutes or less, including forms sent by a Payer or an employer. This code also may be billed when completing the requirements outlined in § 8-43-404(10)(a) or Desk Aid 15 for a non-medical discharge.
DoWC Z0754 | Form Completion | $51.00 |
The term special report includes any form, questionnaire, letter, or report with variable content not otherwise addressed in Rule. Examples include:
The content and total payment shall be agreed upon by the Provider and the report's requester before the Provider begins the report.
Advance Payment: If requested, the Provider is entitled to a two hour deposit in advance in order to schedule a patient exam associated with a special report.
DoWC Z0755 Written Report, $95.37 billable in 15 minute increments
DoWC Z0757 Lengthy Form, $95.37 billable in 15 minute increments
DoWC Z0758 Meeting and Report with Non-treating Physician, $95.37 billable in 15 minute increments
In cases of cancellation for special reports not requiring a scheduled patient exam, the Provider shall be paid for the time reasonably spent in preparation up to the date of cancellation.
DoWC Z0761 Report Preparation with Cancelled Patient Exam, $95.37 billable in 15 minute increments
An IME is an objective medical examination of an injured worker performed by a Physician who has not previously treated the injured worker, in order to evaluate prior, current, or proposed treatment, or current condition. The Physician may refer a psychological component of the IME to a Psychologist and incorporate that evaluation into the IME report. In some circumstances, the IME Physician must be Level I or Level II accredited.
RIME: Respondent-requested Independent Medical Examination
DoWC Z0756 RIME Report with patient exam, $95.37 billable in 15 minute increments
Section 8-43-404 requires RIMEs to be recorded in audio in their entirety and retained by the examining Physician for 12 months and made available by request to any party to the case.
DoWC Z0766 RIME Audio Recording, $35.70 per exam
DoWC Z0767 RIME Audio Copying Fee, $24.48 per copy
CIME: Claimant-requested Independent Medical Examination, $95.37 billable in 15 minute increments to the injured worker, DoWC Code Z0770
DIME: Division Independent Medical Examination - see Rule 11
All IME reports must be served concurrently to all parties no later than 20 days after the examination. All IME reports must include an attestation that the billed charges comply with § 8-42-101(3)(a)(I) and Rule 16-8, as well as document the total time spent.
Cancellations:
In cases of a cancelled or rescheduled RIME or CIME, the Provider shall be paid the following fees:
If the Provider is notified of the cancellation of the RIME or CIME at least fourteen days prior to the scheduled examination, the Provider shall be paid the number of hours reasonably spent in preparation, less any deposit paid by the requesting party. DoWC Z0762, $95.37 billable in 15 minute increments.
If the Provider is notified less than fourteen days in advance of a cancelled or rescheduled RIME or CIME, the Provider shall be paid the number of hours reasonably spent in preparation and scheduled for the examination. DoWC Z0763, $95.37 billable in 15 minute increments.
An interpreter may be provided on-site or via video or audio remote interpreting service, based on availability and the preference of the treating Provider.
* Spanish
* Cantonese
* Mandarin
* Russian
* Korean
* Vietnamese
* Arabic
When reasonably necessary for employees who are legally incapacitated as a result of a work-related injury or occupational disease, the following services are allowed reasonable fees and costs as agreed upon by the parties:
Guardian ad litem
Conservator
Attorney/Paralegal
The parties may submit an invoice or other agreed upon form for these services. If the parties are unable to agree on a reasonable fee, the parties may bring the matter before the Director for resolution.
7 CCR 1101-3-18-7