Key Features of Arkansas Workers' Compensation Medical Fee Schedule
Arkansas sets a state‑approved fee schedule that caps reimbursement rates for medical services rendered to injured workers. Rates are tied to the Arkansas Workers' Compensation Medical Fee Schedule (AWCMFS), which references the Medicare Physician Fee Schedule with a state‑specific conversion factor. The schedule applies to physicians, chiropractors, physical therapists, and other providers, and includes limits on diagnostic tests, surgical procedures, and ancillary services.
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How Rates Are Determined
The AWCMFS uses a two‑step calculation: first, the Medicare relative value unit (RVU) for a service is identified; second, Arkansas applies a conversion factor (currently set by the Arkansas Workers' Compensation Commission) to convert the RVU into a dollar amount. Adjustments may be made for geographic cost variations, but the base schedule remains uniform across the state.
Common Service Categories and Typical Limits
Below is a snapshot of typical reimbursement caps for frequently billed services:
| Service Category | Typical Maximum Reimbursement | Notes |
|---|---|---|
| Office Visit (new patient) | $85‑$110 | Based on CPT 99202‑99205 |
| Office Visit (established) | $65‑$90 | Based on CPT 99212‑99215 |
| X‑ray (single view) | $30‑$45 | Limited to one view per body part per claim |
| Physical Therapy (30‑minute session) | $55‑$70 | Maximum of 20 sessions per injury unless authorized |
| Surgical Procedure (major) | Varies by CPT | Subject to pre‑approval and documentation |
Claim Submission and Approval Process
Providers must submit claims using the Arkansas Workers' Compensation Claim Form (WC‑100) and attach supporting documentation that matches the fee schedule codes. The employer's insurer reviews the claim for compliance with the schedule; any excess charges are either reduced to the schedule rate or denied. Prompt appeals are allowed if a provider believes the schedule does not reflect the true cost of care.
Exceptions and Special Situations
While the fee schedule is mandatory, the Arkansas Workers' Compensation Commission can grant exceptions for out‑of‑state specialists, experimental treatments, or services not listed in the schedule. Such exceptions require a formal request, medical justification, and often a higher-level review.
Impact on Employers and Insurers
Employers benefit from predictable medical costs because the schedule caps payments, reducing the risk of unexpected billings. Insurers use the schedule to benchmark claim payouts and to negotiate network contracts with providers who accept the state‑mandated rates.