Tennessee Administrative Code

(1) Disability and medical benefits are deemed paid when the correct payments have been addressed to the last known address of the proper recipient and deposited in the U.S. Mail or when funds are transferred to a financial institution for deposit in the proper recipient’s accoun…

(1) All medical costs owed under the Tennessee Workers’ Compensation Law shall be paid pursuant to the Medical Fee Schedule contained in Rules 0800-02-17, 0800-02-18 and 0800- 02-19. November, 2025 (Revised) 7 CLAIMS HANDLING STANDARDS CHAPTER 0800-02-14 (Rule 0800-02-14-.07, con…

(1) The permanent impairment rating and date of maximum medical improvement determined by the treating physician, and other information needed to settle a claim shall be documented in writing on a form prescribed by the Administrator and provided, at no cost, to the Employee with…

(1) The appropriate resolution form must be submitted to the Bureau in all claims when they are resolved. (a) In matters concluded by settlement or resolved by trial, the Employer or the Employer’s agent must file a fully completed appropriate version of the Statistical Data Form…

(1) The Bureau has the authority to monitor and audit the performance of adjusters and adjusting entities to ensure compliance with the Workers’ Compensation Law and Bureau Rules as often as it deems necessary which includes, but is not limited to, the review of the following: (a…

All provisions regarding the detecting, prosecuting, and/or preventing of workers’ compensation fraud shall be governed by T.C.A. § 50-6-127 and Title 56, Chapter 47.

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(1) Licensed physicians may charge their usual and customary fee for providing testimony by deposition to be used in a workers’ compensation claim, provided that such fee does not exceed seven hundred fifty dollars ($750) for the first hour. (2) Depositions requiring over one (1)…

(1) Purpose: (a) Pursuant to Tenn. Code Ann. § 50-6-204, this chapter, together with the Medical Fee Schedule Rules, Chapter 0800-02-18-.01 et seq., and the Inpatient Hospital Fee Schedule Rules, Chapter 0800-02-19-.01 et seq., (collectively hereinafter “Rules”) are hereby adopte…

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The following definitions are for the purposes of and are applicable to the Rules for Medical Payments (Chapter 0800-02-17), the Medical Fee Schedule Rules (Chapter 0800-02-18) and the Inpatient Hospital Fee Schedule Rules (Chapter 0800-02-19): (1) “Law” means Tennessee’s Workers…

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GUIDELINES, AND AMOUNTS, RATE TABLES. (1) Services and medical supplies shall be coded with valid procedure or supply codes of the Healthcare Common Procedure Coding System (“HCPCS”). Level I HCPCS procedure codes (CPT® codes) used in these Rules were developed and copyrighted by…

(1) If a procedure is performed which is not listed in the rate tables, the health care provider shall use an appropriate CPT® procedure code or revenue code, as applicable. The provider shall submit an explanation, such as copies of operative reports, consultation reports, progr…

(1) Modifiers shall be added to the procedure code when the service or procedure has been altered from the basic procedure described by the descriptor. (2) Tennessee state-specific modifiers listed in 0800-02-18 may be added to the procedure code when criteria set forth in chapte…

(1) Certain diagnostic procedures (neurological testing, radiology and pathology procedures, etc.) may be performed by two separate entities that also bill separately for the professional and technical components. When this occurs, the total reimbursement shall not exceed the max…

A CASE. (1) An Independent Medical Examination (“IME”), performed to evaluate the medical aspects of a case (other than one conducted under the Bureau’s MIRR Program), shall be billed using January, 2026 (Revised) 12 RULES FOR MEDICAL PAYMENTS CHAPTER 0800-02-17 (Rule 0800-02-17-…

(1) Unless a waiver is obtained from the Administrator, reimbursement for all health care services and supplies shall be the lesser of (a) the provider’s usual billed charge, (b) the fees listed in the rate tables in the Fee Schedule, after applying any applicable modifiers, meth…

Notwithstanding any other provision of this rule, if an employee has personally paid for a health care service and at a later date an employer is determined to be responsible for the payment for that specific service, then the employee shall be fully reimbursed by the employer. M…

Nothing in these Rules shall preclude the recovery of payment already made for services and bills which may later be found to have been medically paid at an amount which exceeds the maximum allowable payment. Likewise, nothing in these Rules shall preclude any provider from recei…

(1) Except when a waiver has been granted by the Bureau, providers shall not accept and employers shall not pay any amount for health care services provided for the treatment of a covered injury or illness or for any other services encompassed within these Rules, Medical January,…

A provider shall receive payment for a missed appointment if the appointment was arranged by the Bureau, the case manager, or employer and the case manager or employer fails to cancel the appointment not less than one (1) business day prior to the time of the appointment. The pro…

THAN INPATIENT HOSPITAL CARE. (1) Except for inpatient hospital care, a provider shall furnish the employer with a narrative medical report for the initial visit, all information pertinent to the compensable injury, illness, or occupational disease if requested within thirty (30)…

Nothing in this rule shall preclude an employer or an employee from requesting reports from a provider in addition to those specified in Rule 0800-02-17-.15.

(1) Any provider who gives a deposition or appears in person as a witness shall be allowed a fee. The fee for appearance in person as a witness should be negotiated and agreed to in advance. (2) CPT® code 99075 shall be used to bill for a deposition. (3) Licensed physicians shall…

Upon waiver granted by the Bureau, providers rendering medically appropriate care outside of the state of Tennessee to an injured employee pursuant to the Tennessee Workers’ Compensation Law may be paid in accordance with the medical fee schedule, law, and rules governing in the …

(1) Preauthorization shall be required for all non-emergency hospitalizations, non-emergency transfers between facilities, and non-emergency surgery. Decisions regarding authorization shall be communicated to the requesting provider within seven (7) business days of the request b…

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PROVIDERS REGARDING BILLS. Disputes (1) Unresolved disputes between an employer and provider concerning bills due to conflicting interpretation of these Rules and/or the Medical Fee Schedule Rules and/or the Inpatient Hospital Fee Schedule Rules may be submitted within one (1) ye…

(1) Medical Payment Committee (the Committee) Review Procedure: (a) When a valid request for Committee Review is received by the Bureau’s Medical Director, the parties will be notified at least seven (7) business days in advance when the Committee will consider the dispute. The C…