4123-6-08. Bureau fee schedule

(A) Pursuant to division (A)(1)(h) of section 4121.441 of the Revised Code, the administrator of workers' compensation, with the advice and consent of the bureau of workers' compensation board of directors, shall develop, maintain, and publish a provider fee schedule for the various types of billing codes. The administrator hereby adopts the fee schedule indicated in the appendix to this rule, developed with provider and employer input, effective January 1, 2020.

(B) Whether the MCO has elected to retain a provider panel or not, an MCO may contract with providers. Every provider contract shall describe the method of payment to the providers. The MCO shall provide an MCO fee schedule to each provider that contracts with the MCO. The MCO fee schedule may be at different rates than the bureau fee schedule. The MCO shall make the MCO fee schedule available to the bureau as part of its application for certification. The bureau shall maintain the MCO fee schedule as proprietary information.

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Effective: 5/16/2020
Five Year Review (FYR) Dates: 2/28/2020 and 05/01/2025
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31, 4123.05
Rule Amplifies: 4121.12, 4121.44, 4121.441, 4123.66
Prior Effective Dates: 02/16/1996, 01/01/2001, 02/19/2009, 11/08/2009, 10/25/2010, 12/30/2010 (Emer.), 03/21/2011, 12/30/2011 (Emer.), 03/24/2012, 12/27/2012 (Emer.), 03/24/2013, 12/30/2013 (Emer.), 03/28/2014, 12/30/2014 (Emer.), 01/15/2015 (Emer.), 05/01/2015, 12/31/2015 (Emer.), 05/01/2016, 12/30/2016 (Emer.), 05/01/2017, 12/29/2017 (Emer.), 05/01/2018, 12/31/2018 (Emer.), 05/01/2019, 12/31/2019 (Emer.)