DEPARTMENT OF LABOR AND EMPLOYMENT
Division of Workers’ Compensation
7 CCR 1101-3
WORKERS’ COMPENSATION RULES OF PROCEDURE
Rule 18	MEDICAL FEE SCHEDULE

18-5	INSTRUCTIONS AND/OR MODIFICATIONS TO THE DOCUMENTS INCORPORATED BY REFERENCE IN RULE 18-1 
	(E)	Surgery:
		(11)	Platelet Rich Plasma (PRP) Injections
The Medical Treatment Guidelines promulgated by the Director of the Division of Workers’ Compensation (Rule 17) govern when PRP injections are appropriate.  Any PRP injections outside of the Medical Treatment Guidelines require prior authorization.  
The provider shall bill DoWC Z0813 DoWC Z0814, maximum total all-inclusive allowance of $735.00, for PRP injections to any body part.  This includes imaging guidance, harvesting and preparation (if performed), the injection itself, as well as kits and supplies.  
	 
18-6	DIVISION ESTABLISHED CODES AND VALUES 
 (G)	Report Preparation
		(6) 	Functional Assessments: 
 (c)	Medical providers who are Level I or II accredited, or who have completed the Division-sponsored Level I or II accreditation program and have successfully completed the Quality Performance and Outcomes Payment training may bill separately for documenting functional progress made by the injured worker.  The medical providers must utilize both a validated psychological screen and the validated functional data provided by the injured worker or another health care provider.  The medical provider also must document whether the injured worker’s perception of function correlates with clinical findings.  The documentation of functional progress should assist the provider in preparing a successful plan of care, including specific goals and expected time frames for completion, or for modifying a prior plan of care.  The documentation must include:
(i)	Specific testing that occurred, interpretation of testing results, and the weight given to these results in forming a reasonable and necessary plan of care;
(ii)	Explanation of how the testing goes beyond the evaluation and management (E&M) services typically provided by the provider;
(iii)	Meaningful discussion of actual or expected functional improvement between the provider and the injured worker.
If these elements have been met, the billing code and maximum fee are as follows:
DoWC Z0811 DoWC Z0815	$ 80.00 for the initial assessment during which the injured worker provides functional data and completes the validated psychological screen, which the provider considers in preparing a plan of care.  This code also may be used for the final assessment that includes review of the functional gains achieved during the course of treatment and documentation of MMI.
DoWC Z0812 DoWC Z0816	$ 40.00 for subsequent visits during which the injured worker provides follow-up functional data which could alter the treatment plan.  The provider may use this code if the analysis of the data causes him or her to modify the treatment plan.  The provider should not bill this code more than once every 2 to 4 weeks.
DoWC Z0813 DoWC Z0817 $15.00 for rehabilitation visits (OT/PT/biofeedback/etc.) that allow for weekly collection of data points for no more than 6 weeks, to determine whether the injured worker has maximized in functionalities.  Any further sessions require justification based upon functional improvement.