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Colorado Department of Labor and Employment
Division of Workers’ Compensation
7 CCR 1101-3
WORKERS’ COMPENSATION RULES OF PROCEDURE
The Secretary of State
compiles and publishes the administrative rules of the executive agencies of
the state of Colorado in the Code of Colorado Regulations. Notices of
rulemaking, proposed rules, new and amended rules, and Attorney General
rules opinions are published monthly in the companion publication, the
Colorado Register. The official Code and Register published pursuant to §
24-4-103(11), C.R.S., can be accessed from this website. An unofficial
version is produced in print and can be purchased from
LexisNexis
.
Special
Instructions for Rule 17 Medical Treatment Guidelines Exhibits 1-10:
Rule 17 and the Medical
Treatment Guideline Exhibits were revised on September 29, 2005, with an
effective date of January 1, 2006. Those revisions were non-substantive
changes, i.e. reformatting, renumbering and correcting typographical errors.
The 9/29/05 revisions did not include any analysis of medical literature or
substantive update of the rules.
The exhibits
for Rule 17 are available in both MS Word and PDF (print friendly) formats. For ease in
both copying and pasting text, please use the MS Word version of these
documents. In the pdf documents, there is rapid navigation within each pdf document by
using the links provided within the Table of Contents. To view a
desired section within each exhibit, simply click on the corresponding
heading within the Table of Contents. This will take you to the
corresponding page in the pdf document. To return to the Table of
Contents at any time, simply click the button "Return to Table of Contents"
in the upper-right corner of each page. |
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Table of Contents |
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Rule 1
General Definitions and General Provisions
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1-1 |
THE
FOLLOWING DEFINITIONS SHALL APPLY UNLESS OTHERWISE INDICATED IN THESE RULES |
1-5
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REQUESTS FOR ORDERS
UNDER §8-47-203(2), C.R.S. |
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1-2 |
COMPUTATION
OF TIME/DATE OF FILING |
1-6 |
MEDIATION |
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1-3 |
NOTARIZATION
OF AUTHORIZATION FOR RELEASE OF INFORMATION |
1-7 |
PENALTIES |
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1-4 |
SERVICE OF
DOCUMENTS |
1-8 |
EMPLOYER
CREDIT FOR WAGES PAID UNDER §8-42-124(2), C.R.S. |
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Rule 2
Workers’
Compensation Premium Surcharges |
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2-1 |
PREMIUM
REPORTING REQUIREMENTS |
2-4 |
PAYMENT
PERIODS AND CREDITS |
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2-2 |
PAYROLL
REPORTING REQUIREMENTS |
2-5 |
SURCHARGE
RATE |
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2-3 |
COMPUTATION
OF PAYROLL SURCHARGES PAID BY SELF-INSURED EMPLOYERS |
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Rule 3 Insurance Coverage |
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3-1 |
REPORTING REQUIREMENTS FOR
INSURANCE CARRIERS AND EMPLOYERS |
3-4 |
ELECTION TO
REJECT COVERAGE |
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3-2 |
CARRIER
REPRESENTATIVE |
3-5 |
NOTICES TO
EMPLOYEES |
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3-3 |
SELF-INSURED
EMPLOYERS |
3-6 |
FINES FOR
DEFAULTING EMPLOYER |
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Rule 4 Carrier Compliance |
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4-1 |
COMPLIANCE
AUDITS |
4-2 |
FINES |
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Rule 5 Claims Adjusting Requirements |
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5-1
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COMPLETION OF DIVISION
FORMS |
5-8
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ADMISSION FOR
PERMANENT TOTAL DISABILITY BENEFITS |
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5-2
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FILING OF EMPLOYERS’
FIRST REPORTS OF INJURY |
5-9
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REVISING ADMISSIONS |
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5-3
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INITIAL NOTICE TO
CLAIMANT |
5-10
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LUMP SUM PAYMENT OF AN
AWARD |
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5-4
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MEDICAL REPORTS AND
RECORDS |
5-11
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FINAL PAYMENT OF
COMPENSATION |
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5-5 |
ADMISSIONS OF LIABILITY
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5-12
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RECEIPTS |
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5-6
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TIMELY PAYMENT OF
COMPENSATION BENEFITS |
5-13
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INFORMATION ON CLAIMS
ADJUSTING |
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5-7
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PERMANENT PARTIAL
DISABILITY BENEFIT RATES |
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Rule 6
Modification, Termination or Suspension of Temporary Disability Benefits |
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6-1
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TERMINATION OF
TEMPORARY DISABILITY BENEFITS IN CLAIMS ARISING FROM INJURIES ON OR AFTER
JULY 1, 1991 |
6-6
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TERMINATION OR
MODIFICATION OF TEMPORARY DISABILITY BENEFITS DUE TO CONFINEMENT |
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6-2
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TERMINATION OF
TEMPORARY DISABILITY BENEFITS BY AN ADMISSION OF LIABILITY IN CLAIMS ARISING
AFTER JULY 2, 1987 AT 4:16 P.M. AND BEFORE JULY 1, 1991 |
6-7
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TERMINATION OF
TEMPORARY DISABILITY BENEFITS PURSUANT TO THIRD-PARTY SETTLEMENT |
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6-3 |
TERMINATION OF TEMPORARY DISABILITY BENEFITS BY AN
ADMISSION
OF LIABILITY IN CLAIMS ARISING PRIOR TO JULY
2, 1987, AT 4:16 P.M. |
6-8
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FAILURE TO COMPLY WITH
REQUIREMENTS OF RULE 6 |
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6-4
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SUSPENSION,
MODIFICATION OR TERMINATION OF TEMPORARY DISABILITY BENEFITS BY A PETITION |
6-9
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TERMINATION OF
TEMPORARY DISABILITY BENEFITS DUE TO FAILURE TO RESPOND TO AN OFFER OF
MODIFIED EMPLOYMENT FROM A TEMPORARY HELP CONTRACTING FIRM IN CLAIMS FOR
INJURIES OCCURRING ON OR AFTER JULY 1, 1996 |
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6-5
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MODIFICATION OF
TEMPORARY DISABILITY BENEFITS PURSUANT TO STATUTORY OFFSET |
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Rule 7 Closure of Claims, Approval of Settlement Agreements and
Petitions to Reopen |
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7-1 |
CLOSURE OF CLAIMS |
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7-2 |
APPROVAL OF SETTLEMENT AGREEMENTS |
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7-3 |
PETITIONS TO REOPEN |
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Rule 8
Authorized Treating Physician |
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8-1 |
APPLICABILITY |
8-5 |
ONE-TIME
CHANGE OF AUTHORIZED TREATING PHYSICIAN |
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8-2 |
INITIAL REFERRAL |
8-6 |
TRANSFER OF MEDICAL CARE |
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8-3 |
INFORMATION PROVIDED BY DESIGNATED PROVIDERS |
8-7 |
CHANGE OF MEDICAL PROVIDER |
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8-4 |
ON-SITE HEALTH CARE FACILITY |
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Rule 9
Division of Workers’ Compensation Dispute Resolution |
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9-1 |
DISCOVERY |
9-5 |
TRUST DEPOSITS AND
SURETY BONDS |
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9-2 |
MEDIATION, SETTLEMENT
CONFERENCES, PREHEARING CONFERENCES AND ARBITRATION |
9-6 |
CONSOLIDATION |
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9-3 |
PLACE OF FILING |
9-7 |
PENALTY PROCEDURES |
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9-4 |
CLAIM FILES |
9-8 |
ATTORNEY
REPRESENTATION |
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Rule 10
Medical Utilization
Review |
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10-1 |
Requests for Utilization Review |
10-6 |
Composition of Utilization Review Committees |
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10-2 |
Filing a Request for Utilization Review |
10-7 |
Responsibilities of Utilization Review Committee Members |
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10-3 |
Official Notification Of Utilization Review |
10-8 |
Change of Medical Provider |
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10-4 |
Adding Medical Records To The Utilization Review File |
10-9 |
Utilization Review Appeals |
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10-5 |
Selection of Utilization Review Committee Members |
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Rule 11 Division
Independent Medical Examination |
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11-1 |
Qualifications |
11-7 |
IME Follow-Up |
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11-2 |
Appointment Procedures |
11-8 |
Removal of a Physician from the Medical Review Panel |
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11-3 |
Requests for an IME |
11-9 |
Immunity |
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11-4 |
Payments/Fees: Unless the party requesting the IME is determined indigent
pursuant to SECTION 11-11 of this rule, the
following shall apply to payments and fees |
11-10 |
Disputes |
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11-5 |
Multiple Impairment Rating IMEs |
11-11 |
Indigent Claimant |
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11-6 |
Communication with an IME Physician |
11-12 |
TABLE OF DIAGNOSES OR
MEDICAL CONDITIONS – INDEPENDENT MEDICAL EXAMINATIONS PROGRAM |
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Rule 12
Permanent Impairment
Rating Guidelines |
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12-1 |
STATEMENT OF PURPOSE |
12-5 |
PERMANENT MENTAL AND
BEHAVIORAL DISORDER IMPAIRMENT RATINGS |
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12-2 |
PROVIDER
RESPONSIBILITIES |
12-6 |
PERMANENT IMPAIRMENT
RATINGS OF THE EXTREMITIES |
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12-3 |
APPORTIONMENT OF
PERMANENT IMPAIRMENT RATING |
12-7 |
PERMANENT IMPAIRMENT
RATINGS FOR CUMULATIVE TRAUMA |
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12-4 |
PERMANENT PHYSICAL
IMPAIRMENT RATINGS |
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Rule 13
Accreditation of Physicians |
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13-1 |
STATEMENT OF BASIS AND
PURPOSE |
13-3 |
RENEWAL OF ACCREDITATION |
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13-2 |
ACCREDITATION |
13-4 |
REVOCATION OF
ACCREDITATION |
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Rule 14 |
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Applications for Admission and Payment of Benefits from the Major Medical
Insurance Fund, the Medical Disaster Fund and Request for Benefits from the
Subsequent Injury Fund |
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14-1 |
APPLICATIONS FOR
ADMISSION TO THE MAJOR MEDICAL INSURANCE FUND AND MEDICAL DISASTER FUND |
14-4 |
OFFSET OF LIABILITY TO
SUBSEQUENT INJURY FUND FOR ACCIDENTS THAT OCCURRED PRIOR TO 7-1-93 AND
OCCUPATIONAL DISEASES THAT OCCURRED PRIOR TO 4-1-94 |
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14-2 |
APPEAL OF ORDER
DENYING ADMISSION OR DENYING BENEFITS TO THE MAJOR MEDICAL INSURANCE FUND
AND MEDICAL DISASTER FUND |
14-5 |
STATUS OF DIRECTOR ON
BEHALF OF THE SUBSEQUENT INJURY FUND, IN FATAL CASES |
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14-3 |
TERMINATING BENEFITS
FROM THE MAJOR MEDICAL INSURANCE FUND |
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Rule 15 |
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Vocational Rehabilitation Rules Applicable to Claims based upon an Injury or
Illness Occurring prior to July 2, 1987 at 4:16 p.m. |
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15-1 |
STATEMENT OF BASIS AND
PURPOSE |
15-5 |
MODIFICATION, SUSPENSION OR TERMINATION OF THE VOCATIONAL
REHABILITATION PLAN OR VOCATIONAL EVALUATION |
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15-2 |
DEFINITIONS |
15-6 |
REPORTING REQUIREMENT |
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15-3 |
INITIATION OF
VOCATIONAL EVALUATION AND DIRECTOR'S DETERMINATION OF ELIGIBILITY |
15-7 |
QUALIFIED
REHABILITATION VENDOR |
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15-4 |
SUBMISSION AND
IMPLEMENTATION OF THE VOCATIONAL REHABILITATION PLAN |
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Rule 16
Utilization Standards |
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16-1 |
STATEMENT OF PURPOSE |
16-7 |
REQUIRED BILLING FORMS
AND ACCOMPANYING DOCUMENTATION |
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16-2 |
STANDARD TERMINOLOGY
FOR THIS RULE |
16-8 |
REQUIRED MEDICAL
RECORD DOCUMENTATION |
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16-3 |
REQUIRED USE OF THE
MEDICAL TREATMENT GUIDELINES |
16-9 |
PRIOR AUTHORIZATION |
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16-4 |
REQUIRED USE OF THE
MEDICAL FEE SCHEDULE |
16-10 |
CONTEST OF A REQUEST
FOR PRIOR AUTHORIZATION |
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16-5 |
RECOGNIZED HEALTH CARE
PROVIDERS |
16-11 |
PAYMENT OF MEDICAL
BENEFITS |
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16-6 |
BILLING RATES AND FEES |
16-12 |
ONSITE REVIEW OF
HOSPITAL OR OTHER MEDICAL CHARGES |
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Rule 17
Medical Treatment
Guidelines |
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17-1 |
STATEMENT OF PURPOSE |
17-7 |
EXHIBITS TO RULE 17
(For ease in copying and pasting, all exhibits are available in both Adobe PDF and MS Word versions)
You may
download the Adobe Reader for free by clicking here |
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17-2 |
USE OF THE MEDICAL
TREATMENT GUIDELINES |
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Exhibit 1 – Low Back
Pain Medical |
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17-3 |
STANDARD TERMINOLOGY
FOR THIS RULE |
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Treatment Guidelines
(PDF)
(MS Word) |
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17-4 |
PROVIDER'S
RESPONSIBILITIES |
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Exhibit 2 – Carpal
Tunnel Syndrome Medical |
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17-5 |
PROCEDURE FOR
QUESTIONING CARE |
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Treatment Guidelines
(PDF)
(MS Word) |
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17-6 |
FAILURE TO COMPLY |
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Exhibit 3 - Thoracic
Outlet Syndrome |
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Medical Treatment Guidelines
(PDF)
(MS
Word) |
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Exhibit 4 – Shoulder
Injury Medical |
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Treatment Guidelines
(PDF)
(MS
Word) |
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Exhibit 5 – Cumulative
Trauma Disorder |
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Treatment Guidelines
(PDF)
(MS Word) |
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Exhibit 6 – Lower
Extremity Medical |
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Treatment Guidelines
(PDF)
(MS Word) |
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Exhibit 7 – Complex
Regional Pain Syndrome/ |
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Reflex Sympathetic Dystrophy |
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Medical Treatment Guidelines
(PDF)
(MS Word) |
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Exhibit 8 – Cervical
Spine Injury Medical |
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Treatment Guidelines
(PDF)
(MS Word) |
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Exhibit 9 – Chronic
Pain Disorder Medical |
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Treatment Guidelines
(PDF)
(MS Word) |
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Exhibit 10 – Traumatic
Brain Injury Medical |
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Treatment Guidelines
(PDF)
(MS Word) |
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Rule 18
Medical Fee Schedule |
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NEW!
Correction Announcement - Rule 18 - Medical Fee Schedule |
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18-1 |
STATEMENT OF PURPOSE |
Exhibits to Rule 18
(All Exhibits are in
Adobe PDF format)
You may
download the Adobe Reader for free by clicking here |
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18-2 |
STANDARD TERMINOLOGY
FOR THIS RULE |
Exhibit 1 - DRGs
with Relative Weights, Geometric and Arithmetic Means |
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18-3 |
HOW TO OBTAIN COPIES |
Exhibit 2 - Base
Rates and Cost-to-Charge Ratios |
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18-4 |
CONVERSION FACTORS |
Exhibit 3 - Critical Access
Hospitals |
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18-5 |
INSTRUCTIONS AND/OR MODIFICATIONS TO THE RVP |
Exhibit 4 - Outpatient Surgery
Facility Codes and Fees |
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18-6 |
DIVISION ESTABLISHED
CODES AND VALUES |
Exhibit 5 - Rural Primary Care
Facilities |
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18-7 |
DENTAL FEE SCHEDULE |
Exhibit 6 - Dental Fee Schedule |
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