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 Texas Administrative Code (Last Updated: March 27,2024)
 TITLE 28. INSURANCE
 PART 2. TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION
 CHAPTER 134. BENEFITS--GUIDELINES FOR MEDICAL SERVICES, CHARGES, AND PAYMENTS
 SUBCHAPTER C. MEDICAL FEE GUIDELINES

  SECTION 134.240. Designated Doctor Examinations  

Latest version.

  • The following shall apply to designated doctor examinations.

    (1) Designated doctors shall perform examinations in accordance with Labor Code §§408.004, 408.0041, and 408.151 and division rules, and shall be billed and reimbursed as follows:

    (A) Impairment caused by the compensable injury shall be billed and reimbursed in accordance with §134.250 of this title, and the use of the additional modifier "W5" is the first modifier to be applied when performed by a designated doctor;

     (B) Attainment of maximum medical improvement shall be billed and reimbursed in accordance with §134.250 of this title, and the use of the additional modifier "W5" is the first modifier to be applied when performed by a designated doctor;

     (C) Extent of the employee's compensable injury shall be billed and reimbursed in accordance with §134.235 of this title, with the use of the additional modifier "W6";

     (D) Whether the injured employee's disability is a direct result of the work-related injury shall be billed and reimbursed in accordance with §134.235 of this title, with the use of the additional modifier "W7";

     (E) Ability of the employee to return to work shall be billed and reimbursed in accordance with §134.235 of this title, with the use of the additional modifier "W8"; and

     (F) Issues similar to those described in subparagraphs (A) - (E) of this paragraph shall be billed and reimbursed in accordance with §134.235 of this title, with the use of the additional modifier "W9."

     (2) When multiple examinations under the same specific division order are performed concurrently under paragraph (1)(C) - (F) of this section:

    (A) the first examination shall be reimbursed at 100 percent of the set fee outlined in §134.235 of this title;

     (B) the second examination shall be reimbursed at 50 percent of the set fee outlined in §134.235 of this title; and

     (C) subsequent examinations shall be reimbursed at 25 percent of the set fee outlined in §134.235 of this title.
Source Note: The provisions of this §134.240 adopted to be July 7, 2016, 41 TexReg 4839