The Code of Colorado Regulations Utilization Standards require authorized treating physicians managing an injured worker’s claim to sign and submit a completed Physician’s Report of Workers’ Compensation Injury on Form WC 164 following an injured worker’s final visit.
This report must be specified as “Closing” on Item 1 of form. The rule further specifies that items 1-5, 6.B, C, and 7-11 shall be completed and notes that if the injured worker has sustained a permanent impairment (item 10), the following additional information shall be attached at the time MMI is determined:
Requirements for reporting Permanent Injury
Additionally, Rule 16-7 requires the physician to supply this report to the injured worker at the time the form is completed and that the report be submitted to the payer along with its billing no later than 14 days from the date of service.
Report Form
Form WC 164 is required by the Code of Colorado Regulations 1101-3 Workers’ Comp Rules of Procedure Rule 16 for any Physician’s Report of Worker’s Compensation Injury.
Form WC 164 for Physician’s Report of Worker’s Compensation Injury
For additional information on medical billing please refer to DaisyBill’s Colorado Billing Guide.
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