Efforts to Increase Illinois Medical Fee Schedule Thwarted by the IWCC

Earlier this year, the Medical Fee Advisory Board to the Illinois Workers’ Compensation Commission passed a Motion (5-3) recommending that the IWCC increase certain medical CPT coded fees by 30%.  Section 8.2 of the Illinois Workers’ Compensation Act grants the IWCC authority to make changes in the Fee Schedule when there exists “a significant limitation on access to quality healthcare in either a specific field of healthcare services [defined by CPT codes] or a specific geographic limitation on access.”  The motion asked to increase E&M codes for Levels 3, 4, and 5 in all four state regions by 30%. None of those Section 8.2 reasons was delineated when or supported by the Board, which not ironically consists of three employee representatives and two medical representatives against three employer representatives on this issue.

On December 20, 2017, the Illinois Workers’ Compensation Commission in its scheduled meeting voted 5-4 against this Motion.  The reasoning on the part of the five Commissioners in striking this motion was on the grounds that it believes the Illinois Workers’ Compensation Commission does not have authority to simply increase (or decrease) the medical fee schedule, but that this is a task reserved for the legislature.  After all, it was a legislative action that was required to institute a 30% reduction in the fee scheduled back in 2011.  We agree with the decision of the Illinois Workers’ Compensation Commission.

Thanks to Partner G. Steven Murdock  for this important Illinois update. Steve works out of the Chicago and St. Louis offices of Inman and Fitzgibbons and chairs the Firm’s Legislative Watch Committee.


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