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Pennsylvania Workers’ Compensation Act

Statement of Policy

Title 34. Labor and Industry
Part VIII. Bureau of Workers’ Compensation

Chapter 126. Health Care Under the Workers' Compensation Act -- Statement of Policy


§ 126.1. Medical fee updates

When submitting data under § 127.155(c) (relating to medical fee updates on and after January 1, 1995—outpatient acute care providers, specialty hospitals and other cost-reimbursed providers), all codes submitted to the Bureau of Workers’ Compensation shall be based upon the appropriate International Classification of Disease (ICD), Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code. If these codes are not available, providers shall submit data in a form mandated by the United States Department of Health and Human Services as published in 45 CFR Parts 160 and 162 (2000) (relating to general administrative requirements; and requirements), as amended. Providers submitting this data may append an appropriate modifier to the code to account for interfacility distinctions in treatment or billing procedures.