This article covers Idaho’s workers' compensation fee schedule sections for providers, including conversion factors and medicine dispensed by providers.
2026 Payment Calculation Resources
Physicians: RBRVS
Physician Fee Calculation - RVUs and Conversion Factors
IDAPA 17.01.01.803.02 - Acceptable Charges for Medical Services Provided By Physicians Under The Idaho Worker’s Compensation Law.
c. Conversion Factors.
The standard for determining the acceptable charge for a medical service, identified by a code assigned to that service in the latest edition of the Physician's CPT, published by the American Medical Association, as amended, is calculated by the application of the total facility or non-facility Relative Value Unit (RVU) for services as determined by place of service in the latest RBRVS in effect on the first day of January of the current calendar year, to the following corresponding conversion factors.
The procedure with the largest RVU will be the primary procedure and will be listed first on the claim form.
Medical Fee Schedule | |||
Service Category |
Code Range(s) |
Description |
Conversion Factor |
Surgery - Group One |
22000 - 22999 23000 - 24999 25000 - 27299 27300 - 27999 29800 - 29999 61000 - 61999 62000 - 62259 63000 - 63999 |
Spine Shoulder, Upper Arm, & Elbow Forearm, Wrist, Hand, Pelvis & Hip Leg, Knee, & Ankle Endoscopy & Arthroscopy Skull, Meninges & Brain Repair, Neuroendoscopy & Shunts Spine & Spinal Cord |
$135.00 |
Surgery - Group Two |
28000 - 28999 64550 - 64999 |
Foot & Toes Nerves & Nervous System |
$124.00 |
Surgery - Group Three |
0000 - 19999 20000 - 21999 29000 - 29799 30000 - 39999 40000 - 49999 50000 - 59999 60000 - 60999 62260 - 62999 64000 - 64549 65000 - 69999 |
Integumentary System Musculoskeletal System Casts & Strapping Respiratory & Cardiovascular Digestive System Urinary System Endocrine System Spine & Spinal Cord Nerves & Nervous System Eye & Ear |
$88.54 |
Medicine - Group One |
90000 - 90749 94000 - 94999 97000 - 97799 97800 - 98999 |
Immunization, Injections, & Infusions Pulmonary / Pulse Oximetry Physical Medicine & Rehabilitation Acupuncture, Osteopathy, & Chiropractic |
$49.00 |
Medicine - Group Two |
90750 - 92999 93000 - 93999 95000 - 96020 96040 - 96999 99000 - 99607 |
Psychiatry & Medicine Cardiography, Catheterization, Vascular Studies Allergy / Neuromuscular Procedures Assessments & Special Procedures E / M & Miscellaneous Services |
$70.00 |
e. Services Without CPT Code, RVU or Conversion Factor.
The acceptable charge for medical services that do not have a current CPT code, a currently assigned RVU, or a conversion factor will be the reasonable charge for that service, based upon the usual and customary charge and other relevant evidence, as determined by the Commission.
Where a service with a CPT Code, RVU, and conversion factor is, nonetheless, claimed to be exceptional or unusual, the Commission may, notwithstanding the conversion factor for that service set out in Paragraph 02.c, above, determine the acceptable charge for that service, based on all relevant evidence in accordance with the procedures set out in Subsection 06, below.
f. Medicine Dispensed by Physicians.
Reimbursement to physicians for any drug or topical agent, including over-the-counter (OTC), shall not exceed the lesser of the acceptable charge calculated for that medicine as if provided by a Pharmacy under Subsection 04 of this rule, or one hundred thirty percent (130%) of the AWP for the lowest-cost therapeutic equivalent drug.
Reimbursement to physicians for repackaged medicine shall be lesser of the AWP for the medicine prior to repackaging, identified by the National Drug Code (NDC) reported by the original manufacturer, or one hundred thirty percent (130%) of the AWP for the lowest-cost therapeutic equivalent drug.
Reimbursement may be withheld until the original manufacturer's NDC is provided by the physician.
Physicians who dispense medications shall not receive a dispense or compounding fee.
g. Adjustment of Conversion Factors. The conversion factors set out in this rule may be adjusted each fiscal year (FY) by the Commission to reflect changes in inflation or market conditions in accordance with Section 72-803, Idaho Code.
daisyBill Solution
Stay up-to-date on the latest developments in workers’ comp medical billing by subscribing to daisyNews.