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TITLE 28INSURANCE
PART 2TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION
CHAPTER 129INCOME BENEFITS--TEMPORARY INCOME BENEFITS
RULE §129.5Work Status Reports

(a) As used in this section:

  (1) the term "doctor" means either the treating doctor or a referral doctor, as defined by §180.22(c) and (e) of this title (relating to Health Care Provider Roles and Responsibilities);

  (2) "substantial change in activity restrictions" means a change in activity restrictions caused by a change in the injured employee's medical condition which either prevents the injured employee from working under the previous restrictions or which allows the injured employee to work in an expanded and more strenuous capacity than the prior restrictions permitted (approaching the injured employee's normal job);

  (3) "change in work status" means a change in the injured employee's work status from one of the three choices listed in subsection (a)(4) of this section to another of the choices in that subsection; and

  (4) the term "work status" refers to whether the injured employee's medical condition:

    (A) allows the injured employee to return to work without restrictions (which is not equivalent to maximum medical improvement);

    (B) allows the injured employee to a return to work with restrictions; or

    (C) prevents the injured employee from returning to work.

(b) A treating doctor may delegate authority to complete, sign, and file a work status report to a licensed physician assistant authorized under Texas Labor Code §408.025. The delegating treating doctor is responsible for the acts of the physician assistant under this subsection.

(c) The doctor or delegated physician assistant shall file a Work Status Report in the form and manner prescribed by the division.

(d) The doctor or delegated physician assistant shall be considered to have filed a complete Work Status Report if the report is filed in the form and manner prescribed by the division, signed, and contains at minimum:

  (1) identification of the injured employee's work status;

  (2) effective dates and estimated expiration dates of current work status and restrictions (an expected expiration date is not binding and may be adjusted in future Work Status Reports, as appropriate, based on the condition and progress of the injured employee);

  (3) identification of any applicable activity restrictions;

  (4) an explanation of how the injured employee's workers' compensation injury prevents the injured employee from returning to work (if the doctor believes that the injured employee is prevented from returning to work); and

  (5) general information that identifies key information about the claim (as prescribed on the report).

(e) The doctor or delegated physician assistant shall file the Work Status Report:

  (1) after the initial examination of the injured employee, regardless of the injured employee's work status;

  (2) when the injured employee experiences a change in work status or a substantial change in activity restrictions; and

  (3) on the schedule requested by the insurance carrier, its agent, or the employer requesting the report through its insurance carrier, which shall not exceed one report every two weeks and which shall be based upon the doctor's or delegated physician assistant's scheduled appointments with the injured employee.

(f) The Work Status Report filed as required by subsection (e) of this section shall be provided to the injured employee at the time of the examination by hand delivery or electronic transmission if the injured employee agrees to receive the report by electronic transmission, and shall be sent, not later than the end of the second working day after the date of examination, to the insurance carrier and the employer.

(g) In addition to the requirements under subsection (e) of this section, the treating doctor or delegated physician assistant shall file the Work Status Report with the insurance carrier, employer, and injured employee within seven days of the day of receipt of:

  (1) functional job descriptions from the employer listing available modified duty positions that the employer is able to offer the injured employee as provided by §129.6(a) of this title (relating to Bona Fide Offers of Employment); or

  (2) a required medical examination doctor's Work Status Report that indicates that the injured employee can return to work with or without restrictions.

(h) Filing the Work Status Report as required by subsection (g) of this section does not require a new examination of the injured employee.

(i) The doctor or delegated physician assistant shall file the Work Status Report as follows:

  (1) A report filed with the insurance carrier or its agent shall be filed by electronic transmission;

  (2) A report filed with the employer shall be filed by electronic transmission if the doctor or delegated physician assistant has been provided the employer's facsimile number or email address; otherwise, the report shall be filed by personal delivery or mail; and

  (3) A report filed with the injured employee shall be hand delivered to the injured employee or delivered by electronic transmission if the injured employee agrees to receive the report by electronic transmission, unless the report is being filed pursuant to subsection (g) of this section and the doctor or delegated physician assistant is not scheduled to see the injured employee by the due date to send the report. In this case, the doctor or delegated physician assistant shall file the report with the injured employee by electronic transmission if the doctor or delegated physician assistant has been provided the injured employee's facsimile number or email address; otherwise, the report shall be filed by mail.

(j) Notwithstanding any other provision of this title, a doctor or delegated physician assistant may bill for, and an insurance carrier shall reimburse, filing a complete Work Status Report required under this section or for providing a subsequent copy of a Work Status Report which was previously filed because the insurance carrier, its agent, or the employer through its insurance carrier asks for an extra copy. The amount of reimbursement shall be $15. A doctor or delegated physician assistant shall not bill in excess of $15 and shall not bill or be entitled to reimbursement for a Work Status Report which is not reimbursable under this section. Doctors or delegated physician assistants are not required to submit a copy of the report being billed for with the bill if the report was previously provided. Doctors or delegated physician assistants billing for Work Status Reports as permitted by this section shall do so as follows:

  (1) CPT code "99080" with modifier "73" shall be used when the doctor or delegated physician assistant is billing for a report required under subsections (e)(1), (e)(2), and (g) of this section;

  (2) CPT code "99080" with modifiers "73" and "RR" (for "requested report") shall be used when the doctor or delegated physician assistant is billing for an additional report requested by or through the insurance carrier under subsection (e)(3) of this section; and

  (3) CPT code "99080" with modifiers "73" and "EC" (for "extra copy") shall be used when the doctor or delegated physician assistant is billing for an extra copy of a previously filed report requested by or through the insurance carrier.

(k) As provided in §126.6(g) of this title (relating to Order for Required Medical Examinations), a doctor who conducts a required medical examination in which the doctor determines that the injured employee can return to work immediately with or without restrictions shall file the Work Status Report required by this section, but shall do so in accordance with the requirements of §126.6(g).


Source Note: The provisions of this §129.5 adopted to be effective December 26, 1999, 24 TexReg 11420; amended to be effective July 16, 2000, 25 TexReg 6520; amended to be effective October 31, 2018, 43 TexReg 7171

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