WCA Director Issues Telemedicine Directive
3/25/2020 In a further effort to assure the continuation of medical services to injured workers during this time of "social distancing" efforts to slow the spread of the novel coronavirus, WCA Director Loretta Lopez has issued a Director's Order regarding the use of telemedicine in workers' compensation medical cases. This order becomes effective immediately and will remain in place until the restrictions surrounding the virus are lifted, or until implementation of the 2021 Health Care Providers' Fee Schedule, whichever comes first.
Health care providers (HCPs) play a key role in New Mexico's workers' compensation system. Authorized HCPs are any medical care providers licensed in New Mexico or otherwise approved by the WCA Director, including surgeons, psychologists and physical therapists. In addition to helping injured workers recover from injuries to return to work, the HCP also offers opinions that affect claims and benefits.
Find out more in our Health Care Provider Guide.
Interested in Becoming an Independent Medical Examiner (IME)?
Independent Medical Examinations (IMEs) are neutral medical exams provided in certain workers' compensation cases where medical issues need clarification. IMEs can be performed by a single physician or a panel of physicians and specialists. IMEs can be requested by any party, or ordered by a workers' compensation judge.
Interested in becoming an IME provider? The WCA approves providers for independent medical examinations (IMEs) through a process. The application process is annual and will reopen in spring 2021.
Comments on existing IME providers or those under consideration are accepted at the WCA. The comment period for 2020 is between June 1 and June 30, and is now closed.
Find a list of current IME Providers.
Health Care Provider (HCP) Fee Schedules
The WCA's Medical Cost Containment Bureau implements various cost-saving measures for medical services provided to injured or disabled workers. The bureau publishes a fee schedule that governs payment for outpatient services.
The Health Care Provider Fee Schedule (HCPFS) is issued annually by the WCA to set costs for medical procedures. Health care providers are normally limited to receiving payments within the range of the HCPFS. Hospital stays require pre-authorization.
Director Issues CPT Code Directive for COVID-19 Testing
WCA Director Loretta Lopez issued a director's order on July 28, 2020, which supplements the 2020 WCA Health Care Provider Fee Schedule, and recognizes Current Procedural Terminology (CPT) code 87635, at a maximum allowable rate of $91.13. The order remains in place until the WCA implements the 2021 fee schedule, or until it is expressly cancelled by the Director. The code for COVID-19 diagnostic testing was added by the American Medical Association to the CPT 2020, Professional Edition, effective March 13, 2020.
In the 2019 Health Care Provider Fee Schedule and Billing Instructions, there was an omission of text on page 14, under "Materials and Supplies." The last statement in that section should read:
"Materials and supplies provided during a hospital inpatient stay, hospital outpatient treatment or surgery, or emergency room visit shall be reimbursed based on the appropriate hospital ratio."
The correction is retroactive to January 1, 2019.
Provider's Report of Physical Ability (PROPA), a form initiated in the 2018 Fee Schedule.
For the method of payment for Freestanding Ambulatory Surgery Centers, please see page 10 of the Fee Schedule and Billing Instructions.
Ratios Effective January 1, 2019 can be found on page 11 of the Fee Schedule and Billing Instructions document.
Release for Health Care Records
In a workers' compensation case, it may be necessary for a worker to allow a HCP to disclose medical records for the purposes of facilitating and evaluating a workers' compensation claim.
Find the form for Authorization for Use and Disclosure of Health Records.
Approval of Out of State Health Care Provider Forms and Letter
The following forms are downable by clicking on the corresponding icon. The formats are for Adobe PDF. The forms are also available on our forms page.
Official Disability Guidelines
On July 1, 2013, the Work Loss Data Institute's (WLDI) Official Disability Guidelines (ODG) went into effect in New Mexico for the treatment of workers' compensation injuries. All medical services rendered for recommended treatment contained in the most recent edition of Official Disability Guidelines (ODG) are presumed reasonable and necessary.
Read more about the Official Disability Guidelines.
Return to Work
The goal after a workplace illness or injury is getting back to work as quickly as possible. Even if an immediate return to the job isn't possible, light or flex duty may be possible, provided the treating health care provider recommends it and the employer has such work available. The longer a worker is out of work, the greater the chance of never returning to the job.
Find out more about Return to Work.