Click here to access the
2011 Health Care Provider Fee Schedule

The 2007 - 2010 Fee Schedules are temporarily unavailable.

If you are an injured worker, you can receive assistance from any one of our ombudsman. You may call and speak to them, or come to one of our field offices to meet with them - click here for locations.

Approved Independent Medical Examiners updated effective 08/15/11.

B4: Health Care Issues in Workers' Compensation
B8: Quick Facts for Health Care Providers
Comprehensive Guide for Health Care Providers

Hospital Ratios
For method of payment for Freestanding Ambulatory Surgery Centers, please see Rules Governing Payments for Health Care Services, Rule 11.4.7.9(E). Ratio Effective December 31, 2011
Ratio Effective December 31, 2010
Ratio Effective December 31, 2009
Ratio Effective December 31, 2008
Ratio Updated Effective February 11, 2008
Ratio Effective December 31, 2007
Ratio Effective December 31, 2006. Revised 4.4.07
Ratio Effective December 31, 2006
Ratio Effective December 31, 2005
Ratio Effective January 14, 2005
Corrected Ratio Effective December 1, 2004
Ratio Effective August 1, 2004

The WCA provides a comprehensive guidebook for health care providers who treat patients under the New Mexico workers' compensation system: The Health Care Provider's Guide to New Mexico Workers' Compensation - click here to download.

The WCA designed the guidebook for both physicians and administrative staff within the physician's office. It contains 66 pages, and covers topics such as medical decisions required under New Mexico workers' compensation, return to work issues for the provider, billing and payment issues, and more.

The guidebook also contains mandatory and optional forms that the health care professional may find helpful when communicating with parties. Printed copies can be ordered from any WCA office.

Workers' Compensation and HIPAA Privacy
See Also:
Rule 4
HIPAA Compliant Form

To health care providers, payers, and workers:
New federal rules under the Health Insurance Privacy and Accountability Act (HIPAA) require health care providers to provide a new level of protection for the privacy of patients' medical records.

Workers' compensation is exempt from this federal law. However, the Workers' Compensation Administration understands that there could be some confusion as health care providers attempt to adjust their practices to the new federal rules.

It is the desire of the Workers' Compensation Administration to prevent any unnecessary disruption of normal business in the treatment of injured workers and the payment of medical bills.

General guidelines for providers, payers, and patients:
The health care provider must transmit medical information related to the workers' compensation claim to the payer of workers' compensation insurance in order to get paid. The worker is required to permit this information to be transmitted. A worker who refuses could become liable for his own medical payments.

Medical information not related to the workers' compensation claim should not be transmitted to the payer, unless the worker signs a release authorizing the transmission. It is recommended that if the health care provider is treating the worker for anything other than the workers' compensation injury, the health care provider should separate the information so that only workers' compensation-related information is sent to the payer.