| Tennessee WORKERS COMPENSATION COLLECTION PUBLICATIONS AND INFORMATION FOR MEDICAL PROVIDERS |
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Chapter 0800-2-19, the In-patient Hospital Fee Schedule, sets out how hospitals should be
reimbursed. Unlike most of our Medical Fee Schedule, this section, for the most part, is not based on
Medicare methods, but reimburses hospitals on a per day or “per diem” basis. This section also
contains definitions and procedures specifically applicable to inpatient hospital reimbursements.
U & C means the usual and customary amount, which is 80% of billed charges. BR (By Report) means
the procedure is not assigned a maximum fee and requires a written description. Paid at U & C (80% of
billed charges).
When there is no specific methodology in these Rules for reimbursement, the maximum reimbursement
is 100% of Medicare. Whenever there is not Medicare methodology, maximum reimbursement is Usual
& Customary or U & C (80% of billed charges). See Rule 0800-2-18-.02(a).
When extraordinary services resulting from severe head injuries, major burns, severe neurological
injuries, or any injury requiring an extended period of intensive care, a greater fee may be allowed up to
150% of the professional service fees normally allowed under these Rules. This provision does not
apply to In-patient Hospital facility fees. See Rule 0800-2-1.
Out-of-State Medical Services
The Tennessee Medical Fee Schedule Rules apply whenever an injured employee is receiving workers’
compensation benefits under Tennessee law or would be entitled to receive benefits under Tennessee
law, whether the treatment is in Tennessee or any other state.
reimbursed. Unlike most of our Medical Fee Schedule, this section, for the most part, is not based on
Medicare methods, but reimburses hospitals on a per day or “per diem” basis. This section also
contains definitions and procedures specifically applicable to inpatient hospital reimbursements.
U & C means the usual and customary amount, which is 80% of billed charges. BR (By Report) means
the procedure is not assigned a maximum fee and requires a written description. Paid at U & C (80% of
billed charges).
When there is no specific methodology in these Rules for reimbursement, the maximum reimbursement
is 100% of Medicare. Whenever there is not Medicare methodology, maximum reimbursement is Usual
& Customary or U & C (80% of billed charges). See Rule 0800-2-18-.02(a).
When extraordinary services resulting from severe head injuries, major burns, severe neurological
injuries, or any injury requiring an extended period of intensive care, a greater fee may be allowed up to
150% of the professional service fees normally allowed under these Rules. This provision does not
apply to In-patient Hospital facility fees. See Rule 0800-2-1.
Out-of-State Medical Services
The Tennessee Medical Fee Schedule Rules apply whenever an injured employee is receiving workers’
compensation benefits under Tennessee law or would be entitled to receive benefits under Tennessee
law, whether the treatment is in Tennessee or any other state.