Tennessee Administrative Code

CODING REFERENCES. (1) The Medical Fee Schedule of the Tennessee Bureau of Workers’ Compensation (Bureau) is a Medicare-based system with Tennessee Specific Conversion Percentages. These Medical Fee Schedule Rules apply to all injured employees claiming benefits under the Tenness…

(1) Format (a) These Rules address and consist of the following sections: General Guidelines, General Medicine (including Evaluation and Management), General Surgery, Neuro- and Orthopedic Surgery, Radiology, Pathology, Anesthesiology, Injections, Durable Medical Equipment, Impla…

(1) Guidelines define items that are necessary to appropriately interpret and report the procedures and services contained in a particular section and provide explanations regarding terms that apply only to a particular section. (2) The Guidelines found in the editions of Current…

(1) Multiple Procedures: Maximum reimbursement shall be based on 100% of the appropriate Medical Fee Schedule amount listed in the rate tables for the major procedure plus each additional appropriately coded secondary and/or multiple procedures according to Medicare guidelines (i…

(1) General Information and Instructions January, 2026 (Revised) 6 MEDICAL FEE SCHEDULE CHAPTER 0800-02-18 (Rule 0800-02-18-.05, continued) (a) When anesthesia is personally administered by an Anesthesiologist or Certified Registered Nurse Anesthetist (“CRNA”) who remains in cons…

Reimbursement for injection(s) shall include CPT® code 96372 and the appropriate codes listed in the HCPCS section of the rate tables. Other surgery procedure codes defined as injections include the administration portion of payment for the medications billed. Follow the Medicare…

(INCLUDING EMERGENCY ROOM FACILITY CHARGES). (1) Medically appropriate surgical procedures may be performed on an outpatient basis. (a) For the purpose of the Medical Fee Schedule Rules, “ambulatory surgical center” means an establishment with an organized medical staff of physic…

(1) Maximum allowable reimbursement for chiropractic services is the lesser of billed charges or the fees listed in the rate tables (based on 180% Medicare). The number of approved visits shall be limited pursuant to any restrictions in Tenn. Code Ann. § 50-6-204. The same proced…

GUIDELINES. (1) Reimbursement for all physical, speech, and occupational therapy services shall not exceed the lesser of billed charges or the fees listed in the rate tables (based on 180% of Medicare), no matter where the services are performed, except home health services. (2) …

(1) Reimbursement for durable medical equipment (DME) and medical supplies, including home DMEs, infusion and oxygen services, other than implantables, shall be reimbursed at the lesser of the provider’s billed charges or the amount listed in the rate tables (based on 100% of Med…

(1) Orthotics and prosthetics, not supplied under 0800-02-18-.07, should be coded according to the Healthcare Common Procedures Coding System (HCPCS). Maximum reimbursement is the lesser of the billed charge or the amount listed in the rate tables (based on 115% of Medicare). If …

(1) The Pharmacy Fee Guideline maximum allowable amount for prescribed drugs (medicines by pharmacists and dispensing practitioners) under the Tennessee workers’ compensation laws is the lesser of: (a) The provider’s usual charge; (b) A negotiated contract or lower amount; or (c)…

(1) All non-emergency ground and air ambulance service provided to workers’ compensation claimants shall be pre-certified. Emergency ground and air ambulance services may be retrospectively reviewed within three (3) business days. (2) All ground and air ambulance services shall b…

(1) Reimbursement for psychological treatment services by any clinician other than a licensed psychiatrist shall be based on reasonableness and necessity and shall be reimbursed at 85% of the fees listed in the rate tables (based on 200% of Medicare). Treatment by a licensed psyc…

(1) Except when a waiver is 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 the Rules for Medical Payments, Med…

(1) These Inpatient Hospital Fee Schedule Rules are applicable to all inpatient services as defined herein. These include medical, surgical, rehabilitation, and/or psychiatric services rendered in a hospital to injured or ill workers claiming medical benefits pursuant to the Tenn…

(1) “Administrator” means the Chief Administrative Officer of the Bureau of Workers’ Compensation or the Administrator’s designee. (2) “Allowed Charges” or “Allowable Charges” shall mean charges as prescribed in the Bureau’s Rules, or as determined by the Administrator or the Adm…

(1) This section defines the reimbursement procedures and calculations for inpatient health care services by all hospitals. Hospital reimbursement is divided into four (4) groups based on type of admission: (a) Peer Groups: 1. Peer Group 1-surgical or non-surgical (medical); 2. P…

Utilization review shall be performed in accordance with Chapter 0800-02-06.

(1) Pharmacy Services (a) Pharmaceutical services rendered as part of inpatient care are considered inclusive within the Inpatient Fee Schedule and shall not be reimbursed separately. (b) All retail pharmaceutical services rendered shall be reimbursed in accordance with the Pharm…

(1) Except when a waiver is 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 the Rules for Medical Payments, Med…

(1) “Administrator” means the chief administrative officer of the Bureau of Workers’ Compensation with full authority over the MIR Registry Program, or the Administrator’s designee. (2) “Business day(s)” means any day upon which the Bureau is open for business. (3) “Bureau” means…

(1) Purpose. The purpose of the Medical Impairment Rating Registry Program is to comply with and implement Tenn. Code Ann. § 50-6-204(d)(5) and (6) by establishing a resource to resolve disputes regarding the degree of permanent medical impairment ratings for injuries or occupati…

(1) If any provision of these Rules or the application thereof to any person or circumstance is, for any reason, held to be invalid, the remainder of the Rules and the application of the provisions to other persons or circumstances shall not be affected in any respect whatsoever.…

IMPAIRMENT RATING REGISTRY. (1) A physician seeking an appointment to the MIR Registry shall submit a “Physician Application for Appointment to the Certified Physician Program (CPP) and/or Medical Impairment Rating (MIR) Registries” and must satisfy the following qualifications: …

(1) Appointment to the MIR Registry shall expire upon a physician’s decision to withdraw from the Registry or the Bureau’s removal of a physician from the Registry. The Bureau reserves the right to charge physicians a non-refundable application fee upon appointment or reinstateme…

(1) When a dispute of the degree of medical impairment, as defined in these Rules exists, any party may request a listing of physicians from the Administrator’s MIR Registry by completing the “Application for Medical Impairment Rating” (hereinafter “Form”), available upon request…

(1) The following timeframes shall exclude legal holidays. A physician performing evaluations under these Rules shall be prepaid by the employer a total evaluation fee for each evaluation performed, under a MIR Registry physician estimated timetable as outlined below (a) Complete…

(1) In instances of more than one impairment rating being disputed in more than one medical specialty, and there is an insufficient number of physicians on the Registry who are qualified to perform all aspects of the evaluation, separate evaluations may be required, each being se…

(1) During the MIR physician selection process, registry physicians cannot render opinions as to the impairment rating to the subject injury to a party to the case in cases in which the physician’s name appears on the three-physician listing. MIR Registry physicians who have rend…

(1) The MIR Registry physician’s responsibilities prior to the evaluation are to: (a) Review all materials provided by the parties subject to these Rules; and, (b) Review the purpose of the evaluation and the impairment questions to be answered in the evaluation report. (2) The M…

(1) After conducting the evaluation, the MIR physician shall produce the “MIR Report.” The format, available by using the Program’s electronic access, available upon request from the Program Coordinator or available online at www.state.tn.us/labor-wfd/mainforms.html, or a materia…

(1) All MIR Reports are subject to peer review for appropriateness and accuracy by a physician designated by the Administrator. (2) The peer review shall be completed within ten (10) business days of referral from the Program Coordinator. The peer review physician may recommend a…

(1) The Administrator may remove a physician from the MIR Registry. In doing so, the Administrator shall first notify the physician in writing that he or she is at risk of being removed from the MIR Registry. The Administrator may remove a physician from the MIR Registry permanen…

(1) Failure by an employer or insurer to pre-pay the evaluation fee shall allow the physician to charge the employer a $100.00 late fee in addition to the evaluation fee. If the evaluation fee and/or late fee remains unpaid fifteen (15) calendar days following the date of the eva…

(1) All time limits referenced in these Rules may be extended by the Administrator or Program Coordinator.

(1) Injured workers, employers, insurers and physician offices shall cooperate in good faith with the Bureau in scheduling MIR Registry evaluations. They shall also cooperate in good faith with all reasonable requests made by any MIR Registry physician.

(1) Parties are prohibited from seeking a second MIR Registry impairment rating for the same injury if an impairment rating was issued after the first MIR Registry evaluation.

These rules govern the procedures for workers’ compensation disputes before the court of workers’ compensation claims and alternative dispute resolution. They are intended to provide an efficient, expedient, and fair resolution of workers’ compensation disputes in accordance with…

(1) Administrator. The chief administrative officer of the Bureau of Workers’ Compensation. (2) Appeals Judge. A judge of the workers’ compensation appeals board. (3) Appeals Board. The workers’ compensation appeals board. (4) Bureau. The Bureau of Workers’ Compensation. (5) Cata…

(1) Unless otherwise noted, the time required for completing any actions in these rules is calculated as in Rule 6.01 of the Tennessee Rules of Civil Procedure. (2) Except for filing a petition for benefit determination under T.C.A. § 50-6-203 and a request for hearing under T.C.…

(1) At any hearing or alternative dispute resolution: (a) Any party may be represented by a Tennessee-licensed attorney in good standing. (b) Any party who is a natural person may represent himself or herself. (c) Any corporation or other artificial person may participate in alte…

The bureau may admit foreign attorneys to appear pro hac vice by application on a form approved by the Administrator.

The employer must pay a filing fee of one hundred and fifty dollars ($150) to the clerk at the time of a settlement approval or the conclusion of a case. A filing fee is assessed at all later settlement approvals or at the conclusion of every re-opening of the case. The filing fe…

All documents filed with the bureau or clerk, including those filed electronically, must be the most recent version approved by the bureau, if a form or template is available. March, 2026 (Revised) 5 COURT OF WORKERS’ COMPENSATION CLAIMS AND CHAPTER 0800-02-21 ALTERNATIVE DISPUTE…

Copies of all documents filed with the bureau or clerk must be served on all parties or their attorneys, if represented. Service must occur either before filing with the bureau or clerk or within a reasonable time afterward. Service may be accomplished by hand delivery, mail or c…

(1) The ombudsman program assists injured or disabled employees, persons claiming death benefits, employers, and other persons in protecting their rights, resolving disputes, and obtaining information. The ombudsman program is available only to those individuals or organizations …