W. Va. Code R. § 85-20-19

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 85-20-19 - Other Non-Covered Services

19.1. Diagnostic Studies. No payment is allowed for:

a. Plethysmography;

b. Temperature gradient studies;

c. Fomentation;

d. Thermography;

e. Routine lab studies in back injury claims; or

f. Routine X-rays which the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, determines, in its sole discretion, are medically unreasonable or medically unsupported as defined under 85 C.S.R. 28.

19.2. Payment to Complete Reports. No payment is allowed for routine status reports, Attending Physician's Report WC-219 Form, other routine reports requested by the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, relating to care that has already been provided, or for completion of the medical portion of the report of injury. Providers shall not charge injured workers or any others for completion of the WC-219 form.

19.3. Miscellaneous. No payment will be made for the following services:

a. Telephone calls;

b. Telephone consultations by providers;

c. Writing or phoning prescriptions;

d. Education materials;

e. Babysitting;

f. Lost or stolen items;

g. Vitamins;

h. Diet pills;

i. Dietary supplements;

j. Weight loss programs;

k. Physical fitness programs;

l. Acupuncture;

m. Swimming therapy/aquatic therapy (unless under direct supervision of a physical therapist);

n. Homeopathy;

o. Massage therapy, except that up to 3 sessions of massage therapy will be allowed if massage therapy is not the sole means of treatment;

p. Copying or supplying needed records;

q. Costs associated with office audits; and

r. Saunas.

W. Va. Code R. § 85-20-19