Fla. Admin. Code R. 69L-7.020

Current through Reg. 50, No. 244; December 17, 2024

Section 69L-7.020 - [Effective 1/1/2025] Florida Workers' Compensation Health Care Provider Reimbursement Manual

(1) The Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2024 Edition (HCP RM) to become effective July 1, 2022, is incorporated by reference as part of this rule. The HCP RM establishes reimbursement policies, guidelines, and procedures for services provided by health care providers. Also, the HCP RM includes reimbursement policies and payment methodologies for pharmacists and medical suppliers. The policies and procedures in the HCP RM are in addition to the requirements and responsibilities established throught rule Chapter 69L-7, F.A.C., Workers' Compensation Medical Reimbursement and Utilization Review.

(2) The Current Procedural Terminology (CPT^®), 2024 Professional Edition, Copyright 2023, American Medical Association; the CDT 2024, Current Dental Terminology, Copyright 2024, American Dental Association; in part, for D codes and for injectable J codes, and for other medical services and supply codes, the Optum 2024 HCPCS Level II, Professional A resourceful compilation of HCPCS codes, Copyright 2023, Optum 360, LLC; the CPT^® Assistant 2024, American Medical Association, Copyright 2023; the Optum 2024 ICD-10-CM Professional for Physicians: The Complete Official Code Set, Copyright 2023, Optum 360, LLC; and the 2024 Relative Value Guide®, A Guide for Anesthesia Values, Copyright 2023, American Society of Anesthesiologists, are incorporated by reference as part of this rule. A copy of the American Medical Association reference materials may be obtained from the American Medical Association's website at https://commerce.ama-assn.org/store/. A copy of the CDT reference material may be obtained from the American Dental Association's website at https://www.ada.org/en/publications/ada-catalog.

(3) Posting the copyrighted materials in subsection (2) above and the HCP RM on the Internet would constitute a violation of federal copyright law. These materials are available for public inspection and examination, but may not be copied, during normal business hours at:

(a) the Florida Department of Financial Services, Division of Workers' Compensation, Bureau of Monitoring and Audit, 1579 Summit Lake Drive, Tallahassee, Florida 32317, or

(b) the Florida Department of State, R.A. Gray Building, 500 South Bronough Street, Tallahassee, Florida 32399-0250. In addition, the HCP RM may be obtained via the Department's Division of Workers' Compensation website at https://www.myfloridacfo.com/Division/wc/.

Fla. Admin. Code Ann. R. 69L-7.020

Rulemaking Authority 440.13, 440.591 FS. Law Implemented 440.13 FS.

New 10-1-82, Amended 3-16-83, 11-6-83, 5-21-85, Formerly 38F-7.20, Amended 4-1-88, 7-20-88, 6-1-91, 4-29-92, 2-18-96, 9-1-97, 12-15-97, 9-17-98, 9-30-01, 7-7-02, Formerly 38F-7.020, 4L-7.020, Amended 12-4-03, 1-1-04, 7-4-04, 5-9-05, 9-4-05, 11-16-06, 10-18-07, 2-4-09, Amended by Florida Register Volume 41, Number 145, July 28, 2015 effective 8/9/2015, Amended by Florida Register Volume 42, Number 071, April 12, 2016 effective 7/1/2016, Amended by Florida Register Volume 42, Number 250, December 28, 2016 effective 7/1/2017, Amended by Florida Register Volume 43, Number 243, December 19, 2017 effective 1/4/2018, Amended by Florida Register Volume 47, Number 208, October 26, 2021 effective Upon ratification by the Legislature, Amended 7/1/2023, Amended by Florida Register Volume 50, Number 244, December 17, 2024 effective 1/1/2025.

Ratified by Ch. 2016-203, LOF, Ch. 2023-144, LOF.