Workers' comp medical fee schedules — verified state by state

In states that publish a workers’ compensation fee schedule, the listed amount is generally the maximum the carrier is required to pay, and the provider may not balance-bill the injured worker for the difference. Specifics — including whether a provider may refuse to treat at the schedule rate — vary by state and are governed by the state’s workers’ compensation statute.

Update cadence is published per jurisdiction. States that benchmark to Medicare (e.g., Florida, Pennsylvania) typically refresh annually when the federal MPFS changes. States with their own schedules update by administrative rule — some annually (California OMFS, Texas MFG, Washington L&I), others only when the agency proposes a new schedule.

Most states route fee disputes through the workers’ compensation agency’s medical fee dispute resolution (MFDR) process. A few use independent bill review — California, for example, uses Maximus Federal under DWC oversight. Each state page lists the appeals path for that jurisdiction.

A handful of states — Indiana, Missouri, New Jersey, and Wisconsin — do not publish a comprehensive medical fee schedule. Reimbursement defaults to usual & customary charges or negotiated rates, with disputes resolved through the state’s workers’ compensation agency under statutory reasonableness standards.

Most states with a published schedule maintain separate sections for hospital inpatient (often DRG-based), hospital outpatient (often APC-based), and ASC services. Reimbursement methodology for facility services frequently differs from the professional-services section.

Pharmacy is commonly addressed in a separate schedule indexed to AWP or NADAC, sometimes with mandatory generic substitution. DME is typically reimbursed via a separate state schedule or by a Medicare-based benchmark.