19 Del. Admin. Code §§ 1341-2.0
The following words and terms, when used in this regulation, have the following meaning:
"Certification" means the certification pursuant to 19 Del.C. § 2322D, required for a Health Care Provider to provide treatment to an employee, pursuant to Delaware's Workers' Compensation Statute.
"Certification of Health Care Providers in an Inpatient Hospital Setting." With regard to health care provider certification as required by 19 Del.C. § 2322D, such certification applies to physicians, chiropractors, and physical therapists providing treatment to an injured worker during his or her period of inpatient hospitalization; all other personnel employed by a hospital providing treatment to an injured worker during his or her period of inpatient hospitalization are excluded from certification.
"CPT" means Current Procedural Terminology, copyright American Medical Association (AMA). CPT codes are also known as Healthcare Common Procedure Coding System (HCPCS) Level 1 and is the numeric medical coding system used in the HCPS for the professional services, as well as hospital outpatient, and ambulatory surgery centers fee schedules.
"Department" means the Department of Labor.
"Fee Schedule Amounts" mean the fees as set forth by the Health Care Payment System.
"Forms" means the standard health care provider and employer forms for the provision of health care services set forth in 19 Del.C. § 2322E.
"Geozip" means the geographical area used to determine the "Delaware specific geographically adjusted factor" mandated in 19 Del.C. § 2322B(a).
"HCPCS" means Healthcare Common Procedure Coding System. HCPCS level 1 consists of the American Medical Association's Current Procedure Terminology (CPT. HCPCS level II codes are alphanumeric and primarily include non-physician services, items, and supplies not covered by the Level 1 (CPT) codes.
"Health Care Payment System" means the comprehensive fee schedule promulgated by the Workers' Compensation Oversight Panel to establish medical payments for both professional and facility fees generated on workers' compensation claims.
"Health Care Provider Application for Certification" means the Department's approved application form which Health Care Providers must submit to the Department so that pre-authorization of each health care procedure, office visit or health care service to be provided to the employee is not required.
"MAR" means maximum allowable reimbursement.
"Not Addressed" means when a code or service that is not present in the Delaware Fee Schedule. The code or service shall be reimbursed as a percent of charge per the applicable fee schedule.
"Not Covered" means that a fee is represented by $0.00 on the Delaware Fee Schedule. When a 0% is displayed in either the professional or technical component percentage of the professional fee schedule, the service is considered 100% of the other component. The component with the 0% is not reimbursed Percentage of Charge (POC).
"Utilization Review" means the utilization review program and associated procedures to guide utilization of health care treatments in workers' compensation as set forth in Section 2322F(j), Chapter 23, Title 19, Delaware Code.
"Workers' Compensation Oversight Panel" or "Panel" means the 24 members appointed or serving by virtue of position, pursuant to 19 Del.C. § 2322A, to carry out the provisions of 19 Del.C. Ch. 23.
19 Del. Admin. Code §§ 1341-2.0
18 DE Reg. 577 (1/1/2015)
27 DE Reg. 614 (2/1/2024) (Final)