Georgia State Board of Workers' Compensation Medical Fee Schedule 2‑18: What Providers Need to Know

The 2024 Georgia State Board of Workers' Compensation Medical Fee Schedule 2‑18 updates the hourly rates and procedure fees that providers can bill for workers' compensation cases. The schedule introduces new fee caps, revised overtime rules, and expanded coverage for telehealth services. For local practices, understanding these changes means adjusting billing codes, updating electronic health record (EHR) templates, and training staff on the new compliance requirements. The most noticeable shift is the 5% increase in the standard hourly rate for most medical specialties, while certain high‑cost procedures see a 10% adjustment. Telehealth now counts as a full‑time equivalent visit, allowing providers to bill 100% of the standard fee for virtual encounters when a patient's injury is managed remotely.

Key Changes in Schedule 2‑18

1. Hourly Rate Adjustments: The base hourly rate for physicians rose from $130.00 to $136.50. Nurse practitioners and physician assistants see a similar 5% increase.

2. Telehealth Expansion: Virtual visits are now eligible for full reimbursement under the same fee schedule as in‑person visits, provided the provider meets the Board's credentialing criteria.

3. Procedure Fee Caps: The Board introduced new caps for high‑volume procedures, such as MRI and CT scans, limiting the maximum reimbursable amount to $1,200 per session.

4. Overtime Policy Revision: Overtime billing is now capped at 1.5 times the standard rate, but only for the first 40 hours of a claim. Hours beyond 40 trigger a 2x cap, with a mandatory 30‑minute break.

5. Specialist Surgeons: Surgeons performing elective procedures on workers' compensation patients face a 10% fee reduction to align with public‑sector cost controls.

Compliance Checklist for Practices

• Update billing software to reflect the new hourly and procedure rates.
• Verify telehealth credentialing and ensure patient consent forms are current.
• Train billing staff on overtime caps and the 30‑minute break rule.
• Review existing contracts with insurance carriers for alignment with the new fee caps.
• Maintain detailed documentation of all services rendered to justify the billed amounts.

Impact on Small Practices

For small practices, the schedule changes mean a modest increase in revenue potential per hour but also stricter caps on high‑cost services. Telehealth expansion offers a new revenue stream, especially for practices with limited physical space. However, the new caps on imaging and specialist surgeries require careful financial planning to avoid revenue loss. Practices should conduct a quarterly audit of workers' comp claims to ensure billing aligns with the updated schedule.

FAQs for Georgia Providers

• Can I bill for telehealth visits at the same rate as in‑person visits? Yes, if the provider meets credentialing requirements and the visit is related to a workers' comp injury.

Conclusion

Staying current with Georgia's Medical Fee Schedule 2‑18 is essential for accurate billing, compliance, and maximizing reimbursement. By updating systems, training staff, and monitoring claim patterns, local practices can navigate the new rules efficiently and maintain steady revenue streams from workers' compensation cases.