453-05-4937-m4
DECISION AND ORDER ___, the worker’s compensation claimant in this case, was injured on_____. The provider, a clinic associated with Texas Evaluation and Management Specialists (TEAM), administered a required medical examination on October 24, 2002, and billed for it under CPT Code 99499-L1. The carrier, Lumberman’s Underwriting Alliance (Carrier), declined to pay because the wrong […]
453-05-4903-m4
DECISION AND ORDER The University of Texas System (Carrier) appealed the findings and decision of the Texas Workers’Compensation Commission’s (Commission) Medical Review Division (MRD), which awarded reimbursement to Katy West Houston Anesthesia (Provider) for services rendered on two occasions: April 30, 2003, and May 2, 2003. In this decision, the Administrative Law Judge (ALJ) finds […]
453-05-4886-m4
DECISION AND ORDER Metropolitan Transit Authority Harris County (Carrier) appealed the Findings and Decision of the Texas Workers= Compensation Commission’s Medical Review Division (MRD)[1] granting reimbursement for an anterior extra peritoneal exposure of the spine (approach procedure) provided in conjunction with spinal surgery. The primary procedure performed by the orthopaedic surgeon consisted of a corpectomy […]
453-05-4170-m4
DECISION AND ORDER This case concerns the proper level of reimbursement for the rental and subsequent purchase of an RS4i neuromuscular stimulator, a piece of durable medical equipment (DME). The Administrative Law Judge (ALJ) concludes reimbursement should be at the amounts billed by the Respondent, RS Medical. I. FACTUAL AND PROCEDURAL HISTORY Workers’ compensation claimant […]
453-05-4251-m4
DECISION AND ORDER The Texas A&M University System (Carrier) appealed the findings and decision of the Texas Workers’ Compensation Commission’s (Commission) Medical Review Division (MRD), which awarded additional reimbursement to RS Medical (Provider) for the use of an RS4i neuromuscular stimulator used on two occasions: May 13, 2003, and June 13, 2003. In this decision, […]
453-05-4298-m4
DECISION AND ORDER This case concerns the proper level of reimbursement for the rental and subsequent purchase of an RS4i neuromuscular stimulator, a piece of durable medical equipment (DME). The Administrative Law Judge (ALJ) concludes reimbursement should be at the amounts billed by the Respondent, RS Medical. I.FACTUAL AND PROCEDURAL HISTORY Workers’ compensation claimant __(the […]
453-05-4322-m4
DECISION AND ORDER This case concerns the proper level of reimbursement for the rental of an RS4i neuromuscular stimulator, a piece of durable medical equipment (DME). The Administrative Law Judge (ALJ) concludes reimbursement should be at the amount billed by the Respondent, RS Medical. I. FACTUAL AND PROCEDURAL HISTORY Workers’ compensation claimant __(the Claimant) suffered […]
453-04-7265-m4
DECISION AND ORDER Transcontinental Insurance Company (Carrier), requested a hearing on an order of the Texas Workers’ Compensation Commission’s Medical Review Division[1] (MRD) that it pay OxyMed, Inc. (Provider), for providing certain durable medical equipment (DME) for Claimant. The DME is an external bone growth stimulator. The MRD ordered Provider to pay $2,050 in addition […]
453-05-3779-m4
DECISION AND ORDER This case concerns the proper level of reimbursement for the rental and subsequent purchase of an RS4i neuromuscular stimulator, a piece of durable medical equipment (DME). The Administrative Law Judge (ALJ) concludes reimbursement should be at the amounts billed by the Respondent, RS Medical. I. FACTUAL AND PROCEDURAL HISTORY Workers’compensation claimant __(the […]
453-05-8283-m4-etal
DECISION AND ORDER I. DISCUSSION In SOAH Docket No. 453-05-8283.M4, on July 8, 2005, Dallas Fire Insurance Company (DFIC) requested a hearing to contest the June 30, 2005 Findings and Decision of the Texas Workers’ Compensation Commission (Commission). The Commission ordered reimbursement for services provided by East Harris County Ortho Association (EHCOA) to injured worker__. […]