{"data":{"id":"us-ok/okla.-stat.-tit.-85a-85a-50","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 85A, § 85A-50","heading":"Failure to provide medical treatment - Medical examination","body":"- Fee schedule - Formulary.\n\nA. The employer shall promptly provide an injured employee with\n\nmedical, surgical, hospital, optometric, podiatric, chiropractic and\n\nnursing services, along with any medicine, crutches, ambulatory\n\ndevices, artificial limbs, eyeglasses, contact lenses, hearing aids,\n\nand other apparatus as may be reasonably necessary in connection\n\nwith the injury received by the employee. The employer shall have\n\nthe right to choose the treating physician or chiropractor.\n\nB. If the employer fails or neglects to provide medical\n\ntreatment within five (5) days after actual knowledge is received of\n\nan injury, the injured employee may select a physician or\n\nchiropractor to provide medical treatment at the expense of the\n\nemployer; provided, however, that the injured employee, or another\n\nin the employee's behalf, may obtain emergency treatment at the\n\nexpense of the employer where such emergency treatment is not\n\nprovided by the employer.\n\nC. Diagnostic tests shall not be repeated sooner than six (6)\n\nmonths from the date of the test unless agreed to by the parties or\n\nordered by the Commission for good cause shown.\n\nD. Unless recommended by the treating doctor or chiropractor at\n\nthe time claimant reaches maximum medical improvement or by an\n\nindependent medical examiner, continuing medical maintenance shall\n\nnot be awarded by the Commission. The employer or insurance carrier\n\nshall not be responsible for continuing medical maintenance or pain\n\nmanagement treatment that is outside the parameters established by\n\nthe Physician Advisory Committee or ODG. The employer or insurance\n\ncarrier shall not be responsible for continuing medical maintenance\n\nor pain management treatment not previously ordered by the\n\nCommission or approved in advance by the employer or insurance\n\ncarrier.\n\nE. An employee claiming or entitled to benefits under the\n\nAdministrative Workers' Compensation Act, shall, if ordered by the\n\nCommission or requested by the employer or insurance carrier, submit\n\nhimself or herself for medical examination. If an employee refuses\n\nto submit himself or herself to examination, his or her right to\n\nprosecute any proceeding under the Administrative Workers'\n\nCompensation Act shall be suspended, and no compensation shall be\n\npayable for the period of such refusal.\n\nF. For compensable injuries resulting in the use of a medical\n\ndevice, ongoing service for the medical device shall be provided in\n\nsituations including, but not limited to, medical device battery\n\nreplacement, ongoing medication refills related to the medical\n\ndevice, medical device repair, or medical device replacement.\n\nG. The employer shall reimburse the employee for the actual\n\nmileage in excess of twenty (20) miles round trip to and from the\n\nemployee's home to the location of a medical service provider for\n\nall reasonable and necessary treatment, for an evaluation of an\n\nindependent medical examiner and for any evaluation made at the\n\nrequest of the employer or insurance carrier. The rate of\n\nreimbursement for such travel expense shall be the official\n\nreimbursement rate as established by the State Travel Reimbursement\n\nAct. In no event shall the reimbursement of travel for medical\n\ntreatment or evaluation exceed six hundred (600) miles round trip.\n\nH. Fee Schedule.\n\n1. The Commission shall conduct a review and update of the\n\nCurrent Procedural Terminology (CPT) in the Fee Schedule every two\nrsement for such travel expense shall be the official\n\nreimbursement rate as established by the State Travel Reimbursement\n\nAct. In no event shall the reimbursement of travel for medical\n\ntreatment or evaluation exceed six hundred (600) miles round trip.\n\nH. Fee Schedule.\n\n1. The Commission shall conduct a review and update of the\n\nCurrent Procedural Terminology (CPT) in the Fee Schedule every two\n\n(2) years pursuant to the provisions of paragraph 14 of this\n\nsubsection. The Fee Schedule shall establish the maximum rates that\n\nmedical providers shall be reimbursed for medical care provided to\n\ninjured employees including, but not limited to, charges by\n\nphysicians, chiropractors, dentists, counselors, hospitals,\n\nambulatory and outpatient facilities, clinical laboratory services,\n\ndiagnostic testing services, and ambulance services, and charges for\n\ndurable medical equipment, prosthetics, orthotics, and supplies.\n\nThe most current Fee Schedule established by the Administrator of\n\nthe Workers' Compensation Court prior to February 1, 2014, shall\n\nremain in effect, unless or until the Legislature approves the\n\nCommission's proposed Fee Schedule.\n\n2. Reimbursement for medical care shall be prescribed and\n\nlimited by the Fee Schedule. The director of the Employees Group\n\nInsurance Division of the Office of Management and Enterprise\n\nServices shall provide the Commission such information as may be\n\nrelevant for the development of the Fee Schedule. The Commission\n\nshall develop the Fee Schedule in a manner in which quality of\n\nmedical care is assured and maintained for injured employees. The\n\nCommission shall give due consideration to additional requirements\n\nfor physicians treating an injured worker under the Administrative\n\nWorkers' Compensation Act, including, but not limited to,\n\ncommunication with claims representatives, case managers, attorneys,\n\nand representatives of employers, and the additional time required\n\nto complete forms for the Commission, insurance carriers, and\n\nemployers.\n\n3. In making adjustments to the Fee Schedule, the Commission\n\nshall use, as a benchmark, the reimbursement rate for each Current\n\nProcedural Terminology (CPT) code provided for in the fee schedule\n\npublished by the Centers for Medicare and Medicaid Services of the\n\nU.S. Department of Health and Human Services for use in Oklahoma\n\n(Medicare Fee Schedule) on the effective date of this section,\n\nworkers' compensation fee schedules employed by neighboring states,\n\nthe latest edition of \"Relative Values for Physicians\" (RVP), usual,\n\ncustomary and reasonable medical payments to workers' compensation\n\nhealth care providers in the same trade area for comparable\n\ntreatment of a person with similar injuries, and all other data the\n\nCommission deems relevant. For services not valued by CMS, the\n\nCommission shall establish values based on the usual, customary and\n\nreasonable medical payments to health care providers in the same\n\ntrade area for comparable treatment of a person with similar\n\ninjuries.\n\na. No reimbursement shall be allowed for any magnetic\n\nresonance imaging (MRI) unless the MRI is provided by\n\nan entity that meets Medicare requirements for the\n\npayment of MRI services or is accredited by the\n\nAmerican College of Radiology, the Intersocietal\n\nAccreditation Commission or the Joint Commission on\n\nAccreditation of Healthcare Organizations. For all\n\nother radiology procedures, the reimbursement rate\n\nshall be the lesser of the reimbursement rate allowed\n\nby the 2010 Oklahoma Fee Schedule and two hundred\n\nseven percent (207%) of the Medicare Fee Schedule.\n\nb. For reimbursement of medical services for Evaluation\n\nand Management of injured employees as defined in the\n\nFee Schedule adopted by the Commission, the\n\nreimbursement rate shall not be less than one hundred\n\nfifty percent (150%) of the Medicare Fee Schedule.\nhedule and two hundred\n\nseven percent (207%) of the Medicare Fee Schedule.\n\nb. For reimbursement of medical services for Evaluation\n\nand Management of injured employees as defined in the\n\nFee Schedule adopted by the Commission, the\n\nreimbursement rate shall not be less than one hundred\n\nfifty percent (150%) of the Medicare Fee Schedule.\n\nc. Any entity providing durable medical equipment,\n\nprosthetics, orthotics or supplies shall be accredited\n\nby a CMS-approved accreditation organization. If a\n\nphysician provides durable medical equipment,\n\nprosthetics, orthotics, prescription drugs, or\n\nsupplies to a patient ancillary to the patient's\n\nvisit, reimbursement shall be no more than ten percent\n\n(10%) above cost.\n\nd. The Commission shall develop a reasonable stop-loss\n\nprovision of the Fee Schedule to provide for adequate\n\nreimbursement for treatment for major burns, severe\n\nhead and neurological injuries, multiple system\n\ninjuries, and other catastrophic injuries requiring\n\nextended periods of intensive care. An employer or\n\ninsurance carrier shall have the right to audit the\n\ncharges and question the reasonableness and necessity\n\nof medical treatment contained in a bill for treatment\n\ncovered by the stop-loss provision.\n\n4. The right to recover charges for every type of medical care\n\nfor injuries arising out of and in the course of covered employment\n\nas defined in the Administrative Workers' Compensation Act shall lie\n\nsolely with the Commission. When a medical care provider has\n\nbrought a claim to the Commission to obtain payment for services, a\n\nparty who prevails in full on the claim shall be entitled to\n\nreasonable attorney fees.\n\n5. Nothing in this section shall prevent an employer, insurance\n\ncarrier, group self-insurance association, or certified workplace\n\nmedical plan from contracting with a provider of medical care for a\n\nreimbursement rate that is greater than or less than limits\n\nestablished by the Fee Schedule.\n\n6. A treating physician may not charge more than Four Hundred\n\nDollars ($400.00) per hour for preparation for or testimony at a\n\ndeposition or appearance before the Commission in connection with a\n\nclaim covered by the Administrative Workers' Compensation Act.\n\n7. The Commission's review of medical and treatment charges\n\npursuant to this section shall be conducted pursuant to the Fee\n\nSchedule in existence at the time the medical care or treatment was\n\nprovided. The judgment approving the medical and treatment charges\n\npursuant to this section shall be enforceable by the Commission in\n\nthe same manner as provided in the Administrative Workers'\n\nCompensation Act for the enforcement of other compensation payments.\n\n8. Charges for prescription drugs dispensed by a pharmacy shall\n\nbe limited to ninety percent (90%) of the average wholesale price of\n\nthe prescription, plus a dispensing fee of Five Dollars ($5.00) per\n\nprescription. \"Average wholesale price\" means the amount determined\n\nfrom the latest publication designated by the Commission.\n\nPhysicians shall prescribe and pharmacies shall dispense generic\n\nequivalent drugs when available. If the National Drug Code, or\n\n\"NDC\", for the drug product dispensed is for a repackaged drug, then\n\nthe maximum reimbursement shall be the lesser of the original\n\nlabeler's NDC and the lowest-cost therapeutic equivalent drug\n\nproduct. Compounded medications shall be billed by the compounding\n\npharmacy at the ingredient level, with each ingredient identified\n\nusing the applicable NDC of the drug product, and the corresponding\n\nquantity. Ingredients with no NDC area are not separately\n\nreimbursable. Payment shall be based on a sum of the allowable fee\n\nfor each ingredient plus a dispensing fee of Five Dollars ($5.00)\n\nper prescription.\n\n9. When medical care includes prescription drugs dispensed by a\nthe ingredient level, with each ingredient identified\n\nusing the applicable NDC of the drug product, and the corresponding\n\nquantity. Ingredients with no NDC area are not separately\n\nreimbursable. Payment shall be based on a sum of the allowable fee\n\nfor each ingredient plus a dispensing fee of Five Dollars ($5.00)\n\nper prescription.\n\n9. When medical care includes prescription drugs dispensed by a\n\nphysician or other medical care provider and the NDC for the drug\n\nproduct dispensed is for a repackaged drug, then the maximum\n\nreimbursement shall be the lesser of the original labeler's NDC and\n\nthe lowest-cost therapeutic equivalent drug product. Payment shall\n\nbe based upon a sum of the allowable fee for each ingredient plus a\n\ndispensing fee of Five Dollars ($5.00) per prescription. Compounded\n\nmedications shall be billed by the compounding pharmacy.\n\n10. Implantables are paid in addition to procedural\n\nreimbursement paid for medical or surgical services. A\n\nmanufacturer's invoice for the actual cost to a physician, hospital\n\nor other entity of an implantable device shall be adjusted by the\n\nphysician, hospital or other entity to reflect, at the time\n\nimplanted, all applicable discounts, rebates, considerations and\n\nproduct replacement programs and shall be provided to the payer by\n\nthe physician or hospital as a condition of payment for the\n\nimplantable device. If the physician, or an entity in which the\n\nphysician has a financial interest other than an ownership interest\n\nof less than five percent (5%) in a publically traded company,\n\nprovides implantable devices, this relationship shall be disclosed\n\nto patient, employer, insurance company, third-party commission,\n\ncertified workplace medical plan, case managers, and attorneys\n\nrepresenting claimant and defendant. If the physician, or an entity\n\nin which the physician has a financial interest other than an\n\nownership interest of less than five percent (5%) in a publicly\n\ntraded company, buys and resells implantable devices to a hospital\n\nor another physician, the markup shall be limited to ten percent\n\n(10%) above cost.\n\n11. Payment for medical care as required by the Administrative\n\nWorkers' Compensation Act shall be due within forty-five (45) days\n\nof the receipt by the employer or insurance carrier of a complete\n\nand accurate invoice, unless the employer or insurance carrier has a\n\ngood-faith reason to request additional information about such\n\ninvoice. Thereafter, the Commission may assess a penalty up to\n\ntwenty-five percent (25%) for any amount due under the Fee Schedule\n\nthat remains unpaid on the finding by the Commission that no good-\n\nfaith reason existed for the delay in payment. If the Commission\n\nfinds a pattern of an employer or insurance carrier willfully and\n\nknowingly delaying payments for medical care, the Commission may\n\nassess a civil penalty of not more than Five Thousand Dollars\n\n($5,000.00) per occurrence.\n\n12. If an employee fails to appear for a scheduled appointment\n\nwith a physician or chiropractor, the employer or insurance company\n\nshall pay to the physician or chiropractor a reasonable charge, to\n\nbe determined by the Commission, for the missed appointment. In the\n\nabsence of a good-faith reason for missing the appointment, the\n\nCommission shall order the employee to reimburse the employer or\n\ninsurance company for the charge.\n\n13. Physicians or chiropractors providing treatment under the\n\nAdministrative Workers' Compensation Act shall disclose under\n\npenalty of perjury to the Commission, on a form prescribed by the\n\nCommission, any ownership or interest in any health care facility,\n\nbusiness, or diagnostic center that is not the physician's or\n\nchiropractor's primary place of business. The disclosure shall\n\ninclude any employee leasing arrangement between the physician or\n\nchiropractor and any health care facility that is not the\nsclose under\n\npenalty of perjury to the Commission, on a form prescribed by the\n\nCommission, any ownership or interest in any health care facility,\n\nbusiness, or diagnostic center that is not the physician's or\n\nchiropractor's primary place of business. The disclosure shall\n\ninclude any employee leasing arrangement between the physician or\n\nchiropractor and any health care facility that is not the\n\nphysician's or chiropractor's primary place of business. A\n\nphysician's or chiropractor's failure to disclose as required by\n\nthis section shall be grounds for the Commission to disqualify the\n\nphysician or chiropractor from providing treatment under the\n\nAdministrative Workers' Compensation Act.\n\n14. a. Beginning on May 28, 2019, the Commission shall\n\nconduct an evaluation of the Fee Schedule, which shall\n\ninclude an update of the list of Current Procedural\n\nTerminology (CPT) codes, a line item adjustment or\n\nrenewal of all rates, and amendment as needed to the\n\nrules applicable to the Fee Schedule.\n\nb. The Commission shall contract with an external\n\nconsultant with knowledge of workers' compensation fee\n\nschedules to review regional and nationwide\n\ncomparisons of Oklahoma's Fee Schedule rates and date\n\nand market for medical services. The consultant shall\n\nreceive written and oral comment from employers,\n\nworkers' compensation medical service and insurance\n\nproviders, self-insureds, group self-insurance\n\nassociations of this state and the public. The\n\nconsultant shall submit a report of its findings and a\n\nproposed amended Fee Schedule to the Commission.\n\nc. The Commission shall adopt the proposed amended Fee\n\nSchedule in whole or in part and make any additional\n\nupdates or adjustments. The Commission shall submit a\n\nproposed updated and adjusted Fee Schedule to the\n\nPresident Pro Tempore of the Senate, the Speaker of\n\nthe House of Representatives and the Governor. The\n\nproposed Fee Schedule shall become effective on July 1\n\nfollowing the legislative session, if approved by\n\nJoint Resolution of the Legislature during the session\n\nin which a proposed Fee Schedule is submitted.\n\nd. Beginning on May 28, 2019, an external evaluation\n\nshall be conducted and a proposed amended Fee Schedule\n\nshall be submitted to the Legislature for approval\n\nduring the 2020 legislative session. Thereafter, an\n\nexternal evaluation shall be conducted and a proposed\n\namended Fee Schedule shall be submitted to the\n\nLegislature for approval every two (2) years.\n\nI. Formulary. The Commission by rule shall adopt a closed\n\nformulary. Rules adopted by the Commission shall allow an appeals\n\nprocess for claims in which a treating doctor determines and\n\ndocuments that a drug not included in the formulary is necessary to\n\ntreat an injured employee's compensable injury. The Commission by\n\nrule shall require the use of generic pharmaceutical medications and\n\nclinically appropriate over-the-counter alternatives to prescription\n\nmedications unless otherwise specified by the prescribing doctor, in\n\naccordance with applicable state law.","path":["OK Code","Title 85A"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os85A.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"955f6af5f9ccc8830e77bbc48f1bd1a59848992d00668c3580a0de2c609d9ab9","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-85a-85a-5","next":"us-ok/okla.-stat.-tit.-85a-85a-51"},"notice":"GroundRules: Original legal text. Not legal advice."}