Work comp: Medical benefits -- medical fee schedule

The medical fee schedule was created to describe the maximum amounts that must be paid for reasonable and necessary medical services. The liability for medical charges under the fee schedule is limited to the maximum charge allowed by the schedule at the time of the service or the provider's fee, whichever is lower. If a provider's fee for services exceeds the amount listed in the fee schedule, the price difference is not required to be paid by the insurer, the employer or the employee.

Not all possible services are specifically listed in the fee schedule. If the service provided is not listed, the provider is usually paid 85 percent of the charged fee unless the charges are from a hospital containing 100 beds or fewer, or for certain nursing homes. In those cases, 100 percent of the charges are paid.

• Consolidated medical fee schedule rules as amended, effective Oct. 1, 2010

• More information about the medical fee schedule

Excessive fees

A charge for a health service or medical service is excessive if it meets the criteria outlined in Minnesota Statutes 176.136, subd. 2, items 1 through 4.

Generally, a health or medical service is excessive if:

• the charge exceeds the maximum allowed under the fee schedule;

• the charge is provided at a level, frequency or duration that is above accepted medical or rehabilitation standards;

• a service is outside the scope of practice of the particular provider, or the service is not generally recognized within the particular profession of the provider as being of therapeutic value for a specific injury or condition treated;

• the treatment is deemed to be excessive or inappropriate, pursuant to rules under the workers' compensation statutes; or

• any of the conditions in Minnesota Rules Part 5221.5000 apply.

Independent medical examination (IME) fees

Fees for independent medical examinations (IMEs), including testimony and deposition charges, are established under Minnesota Rules Part 5219.0500. These limits apply regardless of who requested the second opinion. If an employee's attorney has taxable costs for an IME, you should not pay for charges in excess of the maximum fee.