While the cost of a Permanent Partial Disability (PPD) exam usually falls on the workers’ compensation insurer, there are rare situations when the burden falls on an injured worker. Unfortunately, this burden just got a bit heavier for the injured workers to carry.
Effective February 1, 2024, the cost of a PPD evaluation for 2 body parts rose from $911.26 to $950.04. Every year the Nevada Medical Fee Schedule changes in February. These changes dictate what doctors can charge the workers’ compensation insurer for different services. A copy of the current Nevada Medical Fee Schedule can be found here. (Summary below)
PERMANENT PARTIAL DISABILITY REIMBURSEMENT
Nevada Specific Codes:
NV01000 Review records, testing, evaluation, and report (includes evaluation of up to 2 body parts) ……………………..$950.04
NV01001 Failure of an injured employee to appear for appointment ………………………………………. $317.29
NV01002 Addendum necessary to clarify original report ………………………………………..No charge
NV01003 Addendum after review of additional medical records ………………………………………. $317.29
NV01004 Review of medical records and evaluation of each additional body part in excess of initial 2 body parts .. $317.29
NV01005 Organization of medical records in chronological order based on the date of service………………….. per 50 pages $53.51
NV01006 Review of records and report ………………… $474.08
*Nevada Specific Code NV01001 may only be billed if an injured employee is more than 30 minutes late for a scheduled appointment or cancels the appointment less than 24 hours before the scheduled
appointment.
The medical records must be in a printable format and include a cover sheet indicating the number of pages provided to the physician or chiropractor.
All medical records are to be provided to the evaluator in chronological order based on date of service. Separating chronologically organized therapy notes is acceptable.
For the purpose of establishing the maximum allowable payment for the review of medical records and the evaluation of musculoskeletal body parts, the following constitute one body part:
a) The cervical spine
b) The thoracic spine
c) The lumbar spine
d) The pelvis
e) The left upper extremity, excluding the left hand
f) The right upper extremity, excluding the right hand
g) The left hand, including that portion below the junction of the middle and lower thirds of the
left forearm
h) The right hand, including that portion below the junction of the middle and lower third of the
right forearm
i) The left lower extremity
j) The right lower extremity
k) The head
l) The trunk
m) Post-traumatic Stress Disorder Impairments (NRS 616C.180)
Why would an Injured Worker Have to Pay for a PPD Rating Out-of-Pocket?
Two of the most common reasons an injured worker may have to pay for a rating out-of-pocket include:
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- Situations in which the insurer is attempting to close the claim without a rating;
- And when the injured worker disagrees with the resulting percentage from a prior rating evaluation.
Why you should contact an Attorney if your Workers Comp Claim is being closed without a PPD Evaluation
It used to be that an injured worker had to pay for a PPD exam when the insurer closed the claim without a PPD. This is no longer the case. An attorney can usually get a PPD exam without the cost being paid by the injured worker, however, time deadlines may still hinder that ability. Do not hesitate to contact an attorney if your claim is being closed without a PPD evaluation.
If you believe your claim has been unfairly closed without a rating, or that you had an inaccurate rating evaluation, consult an experienced attorney in order to weight the pros and cons of paying the hefty out-of-pocket expense necessary to get a rating yourself. I will review your PPD report free of charge.
Give me a call or send an email for a free consultation if you have questions or concerns about your Nevada workers’ compensation claim.
