Navigating Georgia’s Workers’ Comp Billing for FCEs: Codes, Caps, and Compliance

Master Georgia’s FCE Billing Rules: From Authorization to Payment in 5 Steps.

Absolutely — here is your fully updated version with:

• ✅ Revised unit rate history

• ✅ Clarified MedRisk role as a specialty rehab network

• ✅ All previous structure (title, TOC, compliance, etc.)

Navigating Georgia’s Workers’ Comp Billing for FCEs: Codes, Caps, and Compliance

Table of Contents

1. Georgia-Specific Billing Rules for FCEs

2. Workflow for Handling Workers’ Compensation Referrals

3. Compliance Overview: What It Means in Georgia

4. Tips and Best Practices

5. Resources for Further Information

6. Disclaimer

1. Georgia-Specific Billing Rules for FCEs

Authorized Billing Code

• State-Specific Code: In Georgia, the state-specific billing code FCE01 must be used for Functional Capacity Evaluations under workers’ compensation.

Maximum Reimbursement

• Total Reimbursement Cap: $800.00 per FCE This is the maximum amount payable regardless of time or number of units.

Billing Units and Rate History

• FCEs under code FCE01 are billed in 15-minute increments.

• The per-unit reimbursement rate has evolved:

• While the current cap is $800.00, it's important to check annual SBWC fee schedule updates for changes to per-unit or total allowances.

Documentation Requirements

• A comprehensive written report is mandatory, detailing:

• Accurate time tracking is required to support billed units.

• Clinical notes must justify the scope and necessity of services rendered.

2. Workflow for Handling Workers’ Compensation Referrals in Georgia

Receiving a Referral

• Direct from Insurer:

• Via Specialty Rehab Network (e.g., MedRisk):

Scheduling

• Contact the patient within 5 business days of receiving the referral.

• Provide clear instructions on clothing, medications, and expectations for the day of testing.

Conducting the FCE

• A full FCE generally lasts 2 to 4 hours.

• Assessments may include:

• Time spent must be documented clearly to justify billed units.

Reporting

• Submit the completed report within 48 hours of the evaluation.

• Include:

• Send to the referring party via secure portal, fax, or email depending on instructions.

Billing and Invoicing

• Code: FCE01 (not CPT 97750)

• Billing: In 15-minute increments, but the total billed amount must not exceed $800.00

• Forms:

Payment Timeline

• Direct Insurer: Typically pays within 30 days of invoice receipt

• Network (e.g., MedRisk): Pays within 14–21 days depending on contract and report submission compliance

3. Compliance Overview: What It Means in Georgia

Compliance with Georgia SBWC billing requirements means:

• ✅ Correct Code Usage: Use FCE01, not CPT 97750

• ✅ Respect the Cap: Do not bill more than $800.00 per evaluation

• ✅ Timely and Detailed Documentation:

• ✅ Proper Billing Forms:

• ✅ Fee Schedule Adherence:

4. Tips and Best Practices

• Pre-Authorization: Confirm that the service is authorized in writing before performing the FCE

• Track Time in Real Time: Use logs or software to track the exact duration of each task

• Align with Referral Instructions: If the referral comes from a network (e.g., MedRisk), follow their documentation templates and reporting timelines

• Train Staff: Ensure your billing and clinical team understand Georgia-specific code and cap requirements

5. Resources for Further Information

• Georgia State Board of Workers' Compensation:

• MedRisk Provider Portal: https://www.medrisknet.com/

• General CPT 97750 Resource: https://medibillmd.com/blog/cpt-code-97750/

Disclaimer

The information provided in this document is intended for general guidance and educational purposes only. While we make every effort to ensure accuracy and keep content up to date, billing rules, reimbursement rates, and regulatory policies are subject to change and may vary by jurisdiction or payer. We do not guarantee the completeness or correctness of the information contained herein. Readers are strongly advised to consult with the appropriate regulatory bodies, insurers, or legal advisors to verify all billing practices and requirements prior to implementation. We accept no liability for any decisions made or actions taken based on the information provided.