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Code of Alabama 480-5-5-.37 Out-of-State Medical Providers
(1) Occasionally an employee, whose injury falls under Alabama’s jurisdiction,
may require treatment by a medical provider in another state. Alabama’s fee schedules
are developed under the premise that treatment will be provided in this state. The
hospital and ambulatory surgery fee schedules are unique to that particular Alabama
facility. Other Alabama medical providers’ reimbursement schedules are derived from
the most common payer of health care services in this state.
(2) Code of Alabama, 1975, § 25-5-77 limits the employer’s liability to the prevailing
rate or maximum schedule of fees. Prevailing is defined in Code of Alabama, 1975, § 25-
5-1(15) and Department of Industrial Relations Administrative Code, Rule 480-5-5-.02
(61). If another state has a workers’ compensation fee schedule for that provider type,
that schedule constitutes the prevailing rate for treatment of a workers’
compensation injury.
(3) For any injury under Alabama’s jurisdiction, the out-of-state medical provider is
paid:
(a) According to that state’s workers’ compensation fee schedule for that provider;
(b) According to a mutually negotiated payment rate pursuant to Code of
Alabama, 1975, § 25-5-314; or
(c) According to the Alabama workers’ compensation fee schedule for nonfacility
medical providers.
Author: Workers' Compensation DivisionStatutory Authority: Code of Alabama, 1975,
§25-5-77History: Effective March 21, 2011
(1) Occasionally an employee, whose injury falls under Alabama’s jurisdiction,
may require treatment by a medical provider in another state. Alabama’s fee schedules
are developed under the premise that treatment will be provided in this state. The
hospital and ambulatory surgery fee schedules are unique to that particular Alabama
facility. Other Alabama medical providers’ reimbursement schedules are derived from
the most common payer of health care services in this state.
(2) Code of Alabama, 1975, § 25-5-77 limits the employer’s liability to the prevailing
rate or maximum schedule of fees. Prevailing is defined in Code of Alabama, 1975, § 25-
5-1(15) and Department of Industrial Relations Administrative Code, Rule 480-5-5-.02
(61). If another state has a workers’ compensation fee schedule for that provider type,
that schedule constitutes the prevailing rate for treatment of a workers’
compensation injury.
(3) For any injury under Alabama’s jurisdiction, the out-of-state medical provider is
paid:
(a) According to that state’s workers’ compensation fee schedule for that provider;
(b) According to a mutually negotiated payment rate pursuant to Code of
Alabama, 1975, § 25-5-314; or
(c) According to the Alabama workers’ compensation fee schedule for nonfacility
medical providers.
Author: Workers' Compensation DivisionStatutory Authority: Code of Alabama, 1975,
§25-5-77History: Effective March 21, 2011