The Impact of Fee Schedule Updates on Physician Payments

How Do Fee Schedule Changes Affect Physician Payments?

Physician payments are the largest category of medical expenditures for workers compensation (WC) claims, comprising approximately 40% of medical costs. To ensure injured workers have adequate access to care, and to help keep costs under control, most states have fee schedules that limit how much a medical provider can be reimbursed for a given service.

One of the main functions of NCCI’s legislative analysis process is to determine the impact of such fee schedule updates on medical benefit costs and WC loss costs.

In this study, NCCI examines the relationship between fee schedule updates and payments for physician services in WC. It looks at experience both in- and out-of-network, various types of physician services, and a wide range of percentage changes in fee limits. Below are some of the findings: