Rate Table

The rate tables simplify determining the maximum allowable reimbursement amount for workers' compensation medical services in Tennessee. These tables replace the previous method that required complex calculations based on the Tennessee Medical Fee Schedule. 

The Tennessee Bureau of Workers' Compensation has partnered with FAIR Health to provide free access to the rate tables.

• Easier and faster to determine reimbursement rates. No more complex calculations, simply look up the code in a table and add any applicable modifiers.
• Fewer errors and disputes. Clear and consistent rates reduce disagreements based on interpretations of the fee schedule.
• Improved access to care. Less administrative burden may lead to faster processing of claims.

Tables Simplify Fee Calculations

Previously, providers and payers calculated the maximum allowed reimbursement for medical services provided based on methodologies described in the workers’ compensation fee schedule. Parties had to apply the appropriate multiplier, set forth in the fee schedule, to the Medicare reimbursement according to the Medicare fee schedule in effect on the date services were provided to the workers’ compensation patient.

The rate tables allow all parties to find the maximum allowed reimbursement amount by looking up the code in a table. The tables can also be uploaded into internal data system for query.

Updated Annually

The tables will be updated once per year with an effective date of April 1st and will remain in effect through the following March 31st.

Gap Filled Services

Services not priced by Medicare will be gap filled in the rate tables, when possible, based on data from FAIR Health. The gap filled maximum allowed reimbursements are reviewed and approved by the Administrator of the Tennessee Bureau of Workers’ Compensation in consultation with the Medical Payment Committee and the Advisory Council on Workers’ Compensation in Tennessee.

Resources

• If you have questions about the maximum reimbursement amounts in the rate tables, contact the Bureau at wc.info@tn.gov. 

• Questions specifically about downloading the rate tables can be addressed to FAIR Health Client Services at service@fairhealth.org or by calling 855 301-FAIR (3247).