Section R612-300-4 - General Method For Computing Medical FeesA. Adoption of "CPT" and "RBRVS." The Labor Commission incorporates by reference: Optum Essential RBRVS 2022 annual 1st Quarter Update," edition includes RBRC 23/1120 ("RBRVS" hereafter).B. Medical fees calculated according to the RBRVS relative value unit assigned to each CPT code. Unless some other provision of Title R612 specifies a different method, the RBRVS is to be used in conjunction with the "conversion factors" established in Subsection (C) of this rule to calculate payments for medical care provided to injured workers.C. Conversion Factors. Fees for medical care of injured workers shall be computed by determining the relative value unit ("RVU") assigned by the RBRVS to a CPT code and then multiplying that RVU by the following conversion factors for specific medical specialties: 1. Anesthesiology, 1 unit per 15 minutes of anesthesia: $75;2. Medicine, Evaluation and Medicine codes 99203-99204 and 99213-99214: $62;3. Medicine, all other Evaluation and Medicine codes: $58;4. Pathology and Laboratory: $62;6. Restorative Services: $56;7. Surgery, all 20000 codes, codes 49505 thru 49525, and all 60000 codes: $71;D. Fees for Medical care not addressed by CPT/RBRVS, or requiring unusual treatment.1. The payor and medical provider may establish and agree to a reasonable fee for medical care of an injured worker if:a. neither the CPT/RBRVS or any other provision of Title R612 address the medical care in question; or b. application of CPT/RBRVS or other provisions of Title R612 would result in an inadequate fee due to extraordinary difficulty of treatment.2. If the medical provider and payor cannot agree to a reasonable fee in such cases, the provider can request a hearing before the Commission's Adjudication Division to establish a reasonable fee.Utah Admin. Code R612-300-4
Amended by Utah State Bulletin Number 2014-22, effective 10/22/2014Amended by Utah State Bulletin Number 2014-24, effective 11/24/2014Amended by Utah State Bulletin Number 2016-1, effective 12/8/2015Amended by Utah State Bulletin Number 2016-24, effective 11/28/2016Amended by Utah State Bulletin Number 2018-2, effective 12/27/2017Amended by Utah State Bulletin Number 2018-9, effective 4/9/2018Amended by Utah State Bulletin Number 2019-2, effective 1/1/2019Amended by Utah State Bulletin Number 2020-02, effective 12/23/2019Amended by Utah State Bulletin Number 2021-02, effective 1/1/2021Amended by Utah State Bulletin Number 2022-01, effective 12/23/2021Amended by Utah State Bulletin Number 2023-01, effective 12/27/2022Amended by Utah State Bulletin Number 2024-01, effective 12/27/2023