MEMORANDUM - February 17, 1994

Practitioner Fee Schedule and Amended Practitioner Billing and Payment Guidelines


TO: Self-Insureds, Insurance Carriers, Attorneys, Unions, Medical Practitioners, Commissioners, and Advisory Board Members
FROM: Jesse M. Frankl, Chairman
DATE: February 17, 1994
RE: Practitioner Fee Schedule and Amended Practitioner Billing and Payment Guidelines


We are attaching the Practitioner Fee Schedule Regulation which became effective as a regulation on January 31, 1994. As noted therein, on page 3 (b) (2) the 74th percentile level of the database of the statewide charges is to be utilized. The database can be obtained from Medical Data Research, 5225 Wiley Post Way, Salt Lake City, UT 84116, telephone number 1-800-765-6026.

The Practitioner Billing and Payment Guidelines which were issued on September 30, 1993 have been amended as follows, VII - D. Physical Medicine. shall read as follows:

"D. Physical Medicine. Physical Medicine is defined as that rendered by medical doctors, registered physical therapists, registered occupational therapists, podiatrists and chiropractors using codes such as 97010-97799 and 95831-95834 and 95851-95852. Physical Medicine services will be paid at the published fee schedule. Only up to three services will be payable per day. The three services will include any office visit billed, except the initial evaluation. Payment of up to three services shall not exceed $90.

Multiple body areas of treatment will not be recognized. However, with multiple traumas where additional time may be necessary, pre-authorization of insurer is required for additional payments."

If you have not received a Practitioner Billing and Payment Guidelines, please send a check for $6.00 made payable to Treasurer, State of Conn and send the request to this office.

The Practitioner Fee Schedule and the Practitioner Billing and Payment Guidelines shall only be used for non PPO or Employer Medical Sponsored Approved Plans.