HEALTH CARE PAYMENT SYSTEM

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This site contains the official Delaware Office of Workers’ Compensation Health Care fee schedule. This schedule applies to those medical treatments and procedures that are rendered on or after May 23, 2008 and are covered under 19 Del. C. §2322 of the Delaware Workers' Compensation Act. The fees are based on the criteria set forth in the Act.

Employers, insurance carriers, and other workers’ compensation payers shall use this schedule, and its instructions and guidelines, when paying medical charges submitted by physicians, hospitals, or other medical providers for services covered under the Act.

Payment for medical care covered under the Act shall be the lesser of the health care provider's actual charge or the fee set by the schedule. If, however, the employer/insurer and health care provider enter into a contract for different reimbursement levels, those negotiated amounts will prevail.

Where there is insufficient data to set a defined amount, then a bill shall be paid at the category Percent of Charge rate applied to the actual charge, see fee schedule for specifics. Please refer to the Instructions and Guidelines for out-of-state treatment information.

This fee schedule site contains four additional pages:

If you have questions about the fee schedule, please refer to the Frequently Asked Questions page. If you still have questions or want to participate on our e-mail distribution list, e-mail us at hcpaymentquestions@state.de.us.