Georgia BWC Fee Schedule Sets New Rules for Topicals

Posted on by myMatrixx
MyMatrixx Workers' Compensation Topical Spend

Effective April 1, 2024, the Georgia Board of Workers’ Compensation’s (BWC) newly released medical fee schedule provides guidelines and rules for coding and reimbursement of topical medications. Topical medications are applied to the skin or mucous membranes to treat ailments via a large range of classes including creams, foams, gels, lotions and ointments.

The updated Georgia fee schedule states the following:

  • Topical compounds shall be billed and reimbursed using the fee schedule code that corresponds to its applicable category:

Category

Reimbursement

Description

Category I
GA0801

$80.00
per 30-day supply

Any anti-inflammatory medication or any local anesthetic single agent.

Category II
GA0802

$160.00
per 30-day supply

Any anti-inflammatory agent or agents in combination with any local anesthetic agent or agents.

Category III GA0803

$240.00
per 30-day supply

Any agent(s) other than anti-inflammatory or local anesthetic agents, either alone, or in combination with other anti-inflammatory or local anesthetic agents
  • Regardless of the number and/or type of ingredients, topical medications cannot be reimbursed higher than the Category III fee.
  • The 30-day Maximum Fee Schedule value shall be fractioned down to the amount prescribed and dispensed to the injured worker.
  • Automatic refilling of topical medications is not allowed.

MyMatrixx monitors the activities and news that may have an impact to our clients and the workers’ compensation industry. If you have questions about this update, please contact clinical@mymatrixx.com.