May 19, 2023  
Deb Outwater  
Department of Labor and Economic Opportunity  
Workers’ Compensation Agency  
P.O. Box 30016  
Lansing, MI 48909  
Email: WCINFO@michigan.gov  
RE: Health Care Services Rule Set 2022-42 LE  
Dear Ms. Outwater,  
Healthesystems is a pharmacy and ancillary benefit manager supporting workers’ compensation  
insurance carriers, third-party administrators, and self-insured employers in the state of Michigan. We  
appreciate the opportunity to submit comments in favor of the proposed changes to the Health Care  
Services Rule Set 2022-42 LE. Additionally, we would like to recommend changes regarding dispense  
fees to practitioners for potential consideration in the next annual rule set update.  
Dispense Fees to Practitioners  
We would like to express our appreciation to the Workers’ Compensation Agency for their attention to  
the state-specific code WC700, which is utilized for billing dispense fees. We fully support the proposed  
removal of this code from all relevant sections of the rules. Most providers are unaware that they need  
to bill a separate line for dispense fee using these state-specific codes, as they are not commonly used in  
standard billing practices. Furthermore, it is worth noting that other states have not adopted policies  
that require a separate code for dispense fees. Instead, many payers typically incorporate  
reimbursement for dispense fees into the average wholesale price (AWP) calculation for the drug billed  
with national drug code (NDC) number.  
In relation to dispense fees, we would like to propose a change for the Agency’s consideration in the  
next rule set update. Currently, according to rule R 418.10912 (Billing for Prescription Medications),  
practitioners or healthcare organization, excluding inpatient hospitals, are eligible for one dispense fee  
reimbursement per prescription drug within a 10-day period, except for over the counter (OTC) drugs.  
Our recommendation is that practitioners or healthcare organization should not be reimbursed for the  
dispense fee when dispensing any type of medication. This is because they already receive  
compensation for their services at the time of the office visit within their professional billing codes  
(Evaluation and Management CPT). These codes encompass all services provided to the patient at the  
place of service, including the review of currently prescribed medications and any new medications  
prescribed. Additionally, the dispense fee is intended to cover professional services offered by a  
pharmacist for dispensing medication and any overhead costs associated with maintaining and  
operating a pharmacy.  
To avoid double reimbursement, several states, such as Alabama, Idaho, Mississippi, Tennessee, and  
others, have implemented policies that prohibit physicians from receiving dispensing fees. Considering  
5404 Cypress Center Dr, Suite 210 | Tampa, Florida 33609 Main: 800.921.1880 | Fax: 813.769.1881 www.healthesystems.com  
that the MI Health Care Services rules already prohibit practitioners or healthcare organizations from  
billing dispense fees for OTC medications, we encourage the Agency to also consider disallowing  
dispense fees for all prescription medications. This change would effectively eliminate unnecessary costs  
to system stakeholders.  
We recognize the efforts the Agency has taken to ensure a fair and balanced workers’ compensation  
system. We are grateful for the chance to express our support for this proposal and provide  
recommendations for future rule developments. Thank you for considering our recommendation, and  
we welcome any questions or comments you may have.  
Sincerely,  
Tiffany Grzybowski  
Tiffany Grzybowski  
Analyst, Advocacy and Compliance  
Healthesystems, LLC  
tgrzybowski@healthesystems.com  
5404 Cypress Center Dr, Suite 210 | Tampa, Florida 33609 Main: 800.921.1880 | Fax: 813.769.1881 www.healthesystems.com  
Optum Workers’ Compensation and Auto No-Fault  
175 Kelsey Lane, Tampa, FL 33619  
P: 1-833-486-7886  
workcompauto.optum.com  
May 24, 2023  
LEO/WDCA  
Attention to: Deb Outwater  
Via email: WCINFO@michigan.gov  
RE: Proposed amendments to Workers’ Compensation Health Care Services (HCS) rule set  
Optum Workers’ Compensation and Auto No-Fault (Optum) appreciates the opportunity to provide written comments  
to the Workers’ Disability Compensation Agency (WDCA) on proposed amendments to the Workers’ Compensation  
Health Care Services (HCS) rule set. We specifically write in support of removal of the existing state-specific “WC-  
700” medication dispensing fee billing codes.  
The HCS rules currently reference distinct state-specific dispensing fee codes to be used by providers when billing for  
certain categories of medications. These codes are WC700-G and WC700-B for generic drugs and brand name  
drugs, respectively, and WC700-T for commercially manufactured topical medications. We noticed the HCS Manual  
also still briefly references use of WC700-C for custom, non-sterile compounds.  
Thanks to prior rule amendments, the above-mentioned codes are currently required except for when the NCPDP  
Workers’ Compensation/Property & Casualty Universal Claim Form (WC/PC UCF) is used for billing by an outpatient  
pharmacy. Previously, that exception was not in place. In prior comments, we wrote to recommend these codes be  
removed for billing by pharmacies, and we again thank the WDCA for making that prior change.  
With this current rule-making, we are appreciative of the WDCA’s proposal to go further than that and remove the use  
of these codes altogether. We support this removal, believing that these proprietary codes are unnecessary and often  
add administrative costs and burden to the system for both providers and payers.  
With respect to non-pharmacy, professional provider bills (often physicians dispensing medications from their office),  
there are nationally recognized procedure codes (CPT and HCPCS) for identifying a medication dispensing fee  
charge on a medical bill. This makes codes specific only to one state and one line of insurance unnecessary.  
Additionally, categorization of a billed medication as a brand, generic or topical drug can be, and is already today,  
achieved through submission of the drug product’s National Drug Code (NDC) and use of third-party references  
commonly used by payers and their pharmacy benefit managers (PBMs) throughout the industry (regardless of state  
or insurance line). Other elements submitted on a bill (particularly for pharmacies) also help with categorization.  
Thank you for your consideration of our written support comments. We look forward to working with the WDCA on this  
and other rule developments in the future. Please let us know if you have any questions or require any additional  
information related to our comments.  
Sincerely,  
Adam Fowler  
Manager, Public Policy & Regulatory Affairs  
Optum Workers’ Compensation and Auto No-Fault  
adam.fowler5@optum.com  
May 24, 2023  
Workers’ Disability Compensation Agency  
Rule Set 2022-42 LE  
Lansing, MI 48909  
RE: Support Memo – 2022-42 LE  
Dear Michigan Department of Labor and Economic Opportunity,  
I appreciate the chance to provide feedback on administrative rule set 2022-42 LE,  
regarding the removal of state-specific dispensing fee billing codes. I am writing on  
behalf of the American Association of Payers Administrators and Networks (“AAPAN”)  
to provide comment on behalf of our members addressing the proposed rule. AAPAN is  
the leading national association of preferred provider organizations (“PPOs”), networks,  
pharmacy benefit managers, and administrators in workers’ compensation. Through our  
members, we work on behalf of thousands of injured workers throughout the country,  
including in Michigan.  
We offer our support for the proposed administrative rule changes for the following  
reasons:  
There are nationally recognized procedure codes for identifying a dispensing fee charge  
on a medical bill. We agree that removing the state-specific codes would also remove a  
layer of redundancy in the systems used for properly identifying charges related to  
medical billing and reimbursement. Other elements submitted on a bill - particularly for  
pharmacies - also help payers with categorization for charges, which means that even  
with the absence of these state-specific codes, proper reimbursement for dispensing will  
still be able to happen seamlessly.  
Second, the categorization of a billed medication as a brand, generic or topical drug can  
be, and is already today, achieved through submission of the NDC (National Drug  
Code) and the use of third-party references used by payers and PBMs (Pharmacy  
Benefit Managers). The removal of the state-specific codes allows for administrative  
fluidity and accuracy in ensuring proper reimbursement. These state-specific codes are  
unnecessary and often add administrative costs and burden to the system for both  
providers and payers. This burden or confusion can also, in extreme instances, impact  
injured workers’ ability to access the care they need.  
The proposed change to the regulatory system in Michigan will be a useful stride  
towards further ensuring access to medications for injured workers, with minimal  
burdens for practitioners and payers getting in the way. Removing these state-specific  
codes will make it easier for payors and practitioners to ensure proper and timely  
AAPAN Support Memo – 2022-42 LE  
Page 2  
reimbursement without confusion. For these reasons we cordially voice our support for  
the removal of these codes in administrative rules set 2022-42 LE.  
We appreciate this opportunity to provide feedback on this important policy issue, and  
we offer our assistance should you have any questions on achieving this policy goal or  
our comments generally.  
Sincerely,  
Julian Roberts  
President and CEO  
American Association of Payers Administrators and Networks (AAPAN)  
3774 Lavista Road, Suite 101  
Tucker, GA 30084  
o: 404/634-8911 e: jroberts@aapan.org  
20 F Street NW, Suite #700  
Washington, DC 20001  
www.APTQI.com  
Via Electronic Submission  
May 24, 2023  
Depart of Labor and Economic Opportunity  
Workers’ Compensation Agency  
Attention: Deb Outwater  
PO Box 30016  
Lansing, MI 48909  
Re:  
Rule Set 2022-42 LE  
Dear Ms. Outwater:  
This letter represents the collective comments of the Alliance for Physical Therapy Quality and  
Innovation (the “APTQI”) to the Department of Labor and Economic Opportunity Workers’  
Compensation Agency regarding the above referenced Rule Set.  
By way of introduction, we are among the nation’s leading providers of outpatient rehabilitation  
care, and collectively our members operate over 380 outpatient clinical sites in Michigan.  
furnishing therapy services on an annual basis to tens of thousands of injured workers in the state.  
We are writing to express our concern regarding the proposed policy to apply reimbursement  
discounts to services provided by physical therapy assistants (PTAs) and occupational therapist  
assistants (OTAs) to injured workers whose care falls under Michigan’s workers compensation  
regulations.  
Following the pandemic, more than 20% of physical therapy and occupational therapy  
professionals left their profession. This has created an acute labor shortage among rehabilitation  
professionals to provide care to injured workers and assure that the labor force in Michigan is  
productive and injury-free. This reduction in the workforce has resulted in labor costs increasing  
by more than 10% in the Michigan market. Retaining staff has become tremendously challenging,  
particularly within rural markets and for specialty services like hand therapy. Additional cuts in  
reimbursement would further challenge providers’ ability to provide care to the injured worker  
population given the challenges of finding and retaining staff with these high labor costs.  
Furthermore, to decrease opioid prescriptions in all settings, there must be appropriate  
reimbursement and access to a broad range of pain management and treatment services, including  
non-pharmacological alternatives to opioids, such as physical therapy. Opioid  
prescription guidelines issued by the Centers for Disease Control and Prevention (CDC) in 2016  
reinforce this notion, describing non-pharmacological treatments such as physical therapy as low-  
risk options which can “ameliorate chronic pain.” The guideline goes on to say physical therapy,  
20 F Street NW, Suite #700  
Washington, DC 20001  
www.APTQI.com  
among other pain treatments, often incur lower annual costs than opioid-based therapies, making  
physical therapy not only less conducive to risk, but also more cost-effective. With all these  
findings, physical therapy clearly has the potential to play a crucial role in establishing non-  
medication-based treatment alternatives to opioids. It is essential to recognize this value and assure  
that injured workers in Michigan have access to physical therapy.  
APTQI is requesting the agency reject this proposal in order to preserve access to care for the  
injured worker in Michigan. We would welcome a meeting to provide additional insights on this  
proposed policy change. This meeting can be held at your convenience at a location of your  
convenience. We look forward to your response.  
I can be reached at 713-824-6177 or by email at npatel@aptqi.com.  
Sincerely,  
Nikesh Patel, PT, DPT  
Executive Director  
APTQI  
npatel@aptqi.com  
May 24, 2023  
Department of Labor and Economic Opportunity  
Workers' Compensation Agency  
Administrative Rules for Workers’ Compensation Health Care Services (HCS)  
Rule Set 2022-42 LE  
LEO/WDCA Attention to: Deb Outwater  
PO Box 30016, Lansing, MI 48909  
WCINFO@michigan.gov  
Dear Ms. Outwater,  
The Michigan Chapter of the American Physical Therapy Association (APTA MI) is writing to express  
our disagreement with the proposed application of the proposed CO/CQ modifiers and subsequent  
fee reduction of 15% per the CMS guidelines when those modifiers are used.  
We believe that this is a flawed policy at the CMS level and APTA at the national level is continuing  
our discussions with CMS to reverse or mitigate the damage that has been done by this flawed  
policy. Specifically the AMA CPT ‘always’ therapy codes already account for the utilization of  
assistants in the calculation of the business expense as a part of the RVU process. Therefore, the  
Association continues to assert that it is a flawed policy because the practice expense values for  
physical medicine CPT codes already have been reduced to avoid duplication during the valuation  
process. Certain efficiencies that occur when multiple therapy services are provided in a single  
session were explicitly taken into account when relative values were established for these codes  
In addition this reduction in payment can interfere with the provision of high quality care and access  
to care, with an additional potential to impact patient safety. This is trying to achieve cost savings  
from a skilled professional performing their job vs. looking at imaging or other specialty care. Rural  
areas and underserved populations could also be impacted due to a possible limitation of services.  
Services provided by PT and OT assistants requires supervision of the PT /OT professional,  
equipment, administrative support, etc. without a reduced cost by the company providing the  
service. To suggest a reduction in reimbursement is a direct contradiction to the expected service  
provided and hinders the ability to deliver that service.  
Finally, now that the Worker’s compensation fee schedule is tied to the CMS fee schedule,  
depending on the individual practice and its patient and payer mix, the proposed payment cuts may  
APTA Michigan  
124 West Allegan Street, Suite 1900 ~ Lansing, MI 48933  
contact@aptami.org ~www.aptami.org  
reduce payment for services to that which it may be below the provider cost per visit. In fact CMS  
cuts via sequestration, MPPR reductions and CO/CQ modifier applications, have some practices  
netting less per visit than they did 15 years ago.  
So on behalf of all Physical Therapists in the state of MI, APTA MI asks you to strongly reconsider  
implementing the CMS CO/CQ modifier process or at the very least consider discussion with APTA  
MI a more appropriate di minimis standard for when the CO/CQ modifier would be applied.  
Thank you for your time in reviewing this letter. Please feel free to reach out to us if you have any  
questions or if there is anything we can further clarify.  
Sincerely,  
Edward Mathis, PT, DPT  
President  
APTA Michigan  
124 West Allegan Street, Suite 1900 ~ Lansing, MI 48933  
contact@aptami.org ~www.aptami.org  
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