Medical Services Division
The Medical Services Division establishes and monitors billing and payment policies for medical services rendered to workers' compensation claimants and publishes the Medical Services Provider Manual. Division personnel are available Monday through Friday from 8:00 a.m. to 4:30 p.m. to answer questions pertaining to medical billing and payment policy.
Injured workers who have concerns about their medical care should contact the Claims Department at 803-737-5723.
Updated HCFA 1500 Form
Beginning January 1, 2014, health care providers were able to submit medical payment requests using the revised 1500 form. After March 31, 2014, healthcare providers will no longer be allowed to submit payment requests under the previous versions of the 1500 form.Read more...
Mandatory Payment Reduction in Medicare Fee-for-Service (FFS) Program. This reduction does NOT apply to workers' compensation claims. Read more...
Medical Services Division Advisory Statement - Effective January 1, 2013
Billing and Payment of Professional Fee Revenue Codes 960 through 999
Medical Bill Dispute Resolution Process
Click here for instructions on filing and resolution of medical billing issues. Please note that submittal of a dispute form must follow proper process and incomplete submittals will not be considered.
2010 Medical Services Provider Manual
Any appropriately-licensed medical provider who is authorized by the employer or insurance carrier may treat workers' compensation claimants. The Medical Services Provider Manual outlines billing and payment policy for physicians and other health care professionals and provides the current schedule of fees. The fee schedule does not cover hospital charges, general dental, EMS Services, Emergency Air Transportation, or services rendered outside of South Carolina.
Copies of the manual may be purchased for $75.00. Click the following link for ordering instructions: 2010 Medical Services Provider Manual
2010 Medical Services Provider Manual Pricing Corrections
and Revisions Effective January 1, 2013
2010 Medical Services Provider Manual, Section 2, ANESTHESIA
Pharmacy Fee Schedule Effective December 19, 2011
2006 Hospital and Ambulatory Surgical Center Payment Manual
The Hospital and Ambulatory Surgery Center Payment Manual describes the billing and payment policy for inpatient hospital stays and outpatient services rendered at a hospital or ambulatory surgical center. Effective October 1, 2006, healthcare facilities will be paid 40% more than the federal Medicare program pays for inpatient and outpatient services.
Click the links below to download a PDF version of the 2006 or 1997 Hospital and Ambulatory Surgery Center Payment Manuals:
2006 Hospital and Ambulatory Surgery Center Payment Manual
Claims for inpatient hospital stays are paid according to a payment system based on diagnosis related groups (DRGs). DRG is a system of classifying an inpatient stay based on the patient’s diagnosis, medical condition and any procedures performed. Payments are hospital-specific to account for factors such as rural/urban, number of indigent patients, teaching hospital, etc.
Claims for outpatient services rendered at a hospital are paid based on grouping outpatient services into ambulatory payment classifications (APCs). Services within an APC are similar clinically and require comparable resources. Each APC is assigned a relative payment rate based on the median cost of the services within that classification.
Commission Amends Fee Schedule for Ambulatory Surgery Centers
Surgically Implanted Devices
Effective April 15, 2013, the Maximum Allowable Payment (MAP) for procedures performed in an Ambulatory Surgery Center will be calculated at 140% of the Medicare Payment for procedures plus the total cost of all surgical implants per case with Revenue Codes 274, 276, and 278 minus a five hundred ($500) implant cost reduction per case. Click here to view the amendment.
Ambulatory Surgery Centers, et. al., v.SC Workers' Compensation Commission
Claims for ambulatory surgery center services are paid at the Medicare national payment rate found at www.cms.gov/ASCPayment plus 40%.
Note: The multiple procedures rule still applies and the National Correct Coding Initiative will be utilized in order to determine the appropriate billing of CPT and HCPCS codes
1997 Hospital and Ambulatory Surgery Center Payment Manual
DRG Conversions for 1997 Payment Manual, DRG Updates
Update on "Pass Throughs"