State of Connecticut Workers' Compensation Commission

MEMORANDUM NO. 2018-11

2019 WCC Hospital and Ambulatory Surgical Center Fee Schedule

 

TO: WCC Commissioners, Facility Fee Schedule Core Committee Members, District Administrators, Advisory Board, Legal Advisory Panel, Medical Advisory Panel, Medical Practitioners, Self-Insureds, Insurance Carriers, Medical Care Plans, Attorneys, and Unions.
FROM: Stephen M. Morelli, Chairman
DATE: December 31, 2018
RE: 2019 WCC Hospital and Ambulatory Surgical Center Fee Schedule

 

Pursuant to C. G. S. § 31-294d(d) (as amended June 11, 2014) the following will be in effect for the pecuniary liability of the employer for services rendered by a hospital and ambulatory surgical center:
 

  1. The hospital inpatient rate shall be 174% of the Medicare rate payable to that facility.
     
  2. The hospital outpatient and hospital-based ambulatory surgical center rate shall be 210% of the Medicare rate payable to that facility.
     
  3. The non-hospital based ambulatory surgical center rate shall be 195% of the hospital-based outpatient Medicare rate payable in the same CBSA (Core Based Statistical Area).
     
  4. Where there is no Medicare rate for the services in an outpatient hospital setting, the parties shall negotiate the reimbursement rate. If negotiation is not successful, the parties may request a hearing with the Commission; however, treatment shall proceed pending same.
     

The Workers’ Compensation Commission is working with a vendor to publish the 2019 applicable rates, rules and guidelines for this Fee Schedule. It will be available in advance of the April 1, 2019 effective date. Notice of availability will be published on our website at https://wcc.state.ct.us/.