Maryland

Medical Control

The injured employee may select a treating provider. If the injured employee cannot find a provider
who is willing to accept the rules of the Medical Fee Guide, the injured employee may contact the
employer/insurer for recommendations. The employee may select his/her own pharmacy or select a
pharmacy from the Express Scripts pharmacy network. Emergency medical care does not require
preapproval and should be secured at the nearest location

MEDICAL

•        In Maryland, medical providers can be selected by the (injured worker) claimant; however, if
they cannot find a medical provider in their area who is willing to provide medical treatment (who
is willing to accept the rules of the Medical Fee Guide), it is often suggested that parties should
consider contacting the employer/insurer for suggestions for medical providers in their area (the
insurer is most likely to have data listing participating medical providers in the various regions of
the State, based on their payment records).
•        Maryland Workers’ Compensation Medical Fee Guide (MFG) regulations define the
submission of bills from the medical provider to the employer/insurer, the forms required,
timeliness for payment of medical claims and penalties for untimely reimbursement. This is
specified in the Medical Fee Guide regulations text posted to our Medical Fee Guide information
page.
•        Medical providers are not required to be registered or certified by the WCC.
•        The MD WCC MFG has never priced durable medical equipment (DME),
prescriptions/pharmaceuticals (Rx) or dental procedures; however, medical providers should bill
what is usual and customary: "An insurance carrier may base the assigned value on nationally
recognized and published relative value studies, or on the values assigned for services involving
similar work and resources." Providers are supposed to have one price for all patients regardless of
what they get paid by different payers. If there is a disagreement in the payment, the bill should be
submitted to the Commission for review via the Claim for Medical Services, form C-51.
•        The MFG does not require NCCI edits for billing and generally does not require many CMS
policies that are not referenced in our MFG regulations.
•        Contact the Medical Division via telephone (410) 864-5320, outside Baltimore Metro area
toll free (800) 492-0479 selecting extension 5320 when prompted or via email:
wccsupportserv@wcc.state.md.us

Maryland WORKERS COMPENSATION COLLECTION
PUBLICATIONS AND INFORMATION FOR MEDICAL PROVIDERS

Fee Schedule

December 29, 2011 Maryland News: Medical
Fee Guide informational materials effective
January 1, 2012 are available on the Medical
Fee Guide & Information page.

December 01, 2011: Maryland: News: purpose
to ensure compliance with the guidelines
issued by the Centers for Medicare and
Medicaid Services (CMS) involving the
settlement of future medical benefits

November 07, 2011" Maryland: News:
The Commission and Maryland State offices
are closed Friday, November 11th in
observance of Veterans' Day. We will open for
business at 8 a.m. on Monday, November 14th.

General Information

Publications

Work Comp News and Issues