The Medical Fee Guideline conversion factors are established by 28 Texas Administrative Code §134.203. Under Labor Code §413.011(a), fee guidelines adopted by the Division of Workers’ Compensation (DWC) for non-network services and approved out-of-network services are based on the most current reimbursement methodologies, models, and values or weights used by the federal Centers for Medicare and Medicaid Services.
DWC established a conversion factor and an annual update to provide predictability and reflect changes in medical service delivery costs to system participants. The annual update is based on the Medicare Economic Index (MEI), which is a weighted average of price changes for goods and services used to deliver physician services. The MEI for 2025 reflects an increase of 3.5 percent.
For services provided in calendar year 2025, the new Medical Fee Guideline conversion factors are $70.18 and $88.10. The conversion factor of $70.18 applies to service categories of evaluation and management, general medicine, physical medicine and rehabilitation, radiology, pathology, anesthesia, and surgery when performed in an office setting. The conversion factor of $88.10 applies to surgery when performed in a facility setting.
Questions? Call Comp Connection for Health Care Providers at 800-252-7031 option 3, or email CompConnection@tdi.texas.gov.
| Applicable from | Applicable to | Anesthesia | Evaluation and management | General medicine | Pathology | Physical medicine and rehabilitation | Radiology | Surgery in an office setting | Surgery in a facility setting | MEI percentage adjustment |
|---|---|---|---|---|---|---|---|---|---|---|
| 1/1/25 | 12/31/25 | $70.18 | $70.18 | $70.18 | $70.18 | $70.18 | $70.18 | $70.18 | $88.10 | 3.5% |
| 1/1/24 | 12/31/24 | $67.81 | $67.81 | $67.81 | $67.81 | $67.81 | $67.81 | $67.81 | $85.12 | 4.6% |
| 1/1/23 | 12/31/23 | $64.83 | $64.83 | $64.83 | $64.83 | $64.83 | $64.83 | $64.83 | $81.38 | 3.8% |
| 1/1/22 | 12/31/22 | $62.46 | $62.46 | $62.46 | $62.46 | $62.46 | $62.46 | $62.46 | $78.37 | 2.1% |
| 1/1/21 | 12/31/21 | $61.17 | $61.17 | $61.17 | $61.17 | $61.17 | $61.17 | $61.17 | $76.76 | 1.4% |
| 1/1/20 | 12/31/20 | $60.32 | $60.32 | $60.32 | $60.32 | $60.32 | $60.32 | $60.32 | $75.70 | 1.9% |
Exam fees
DWC adopted amendments to 28 Texas Administrative Code (TAC) Chapter 133, General Medical Provisions and 28 TAC Chapter 134, Benefits--Guidelines for Medical Services, Charges, and Payments to improve billing and reimbursement for certain workers' compensation-specific services. This includes designated doctor (DD) examinations, required medical examinations (RMEs), and maximum medical improvement (MMI) evaluations and impairment rating (IR) examinations by treating doctors (TD) and referred doctors (RD).
On June 1, 2024, revised billing requirements went into effect for services assigned by DWC. There are new rates for exams conducted on or after June 1, 2024. These rates are adjusted annually on January 1 by the Medicare Economic Index (MEI). The MEI for 2025 reflects an increase of 3.5%. For services provided in calendar year 2025, the new rates are listed below.
Exams conducted before June 1, 2024, will be reimbursed according to the prior rules, which included methodologies such as tiering and range of motion.
| Dates of Service | 3/1/2008 - 5/31/2024 | 6/1/2024 - 12/31/2024 | 1/1/2025 - 12/31/2025 |
|---|---|---|---|
| Annual MEI percentage | does not apply | does not apply | 3.50% |
| MMI exam by RD, RME, or DD | $350.00 | $449.00 | $465.00 |
| IR exam first musculoskeletal (MSK) body area by TD, RD, RME or DD | $300.00 | $385.00 | $398.00 |
| IR exam for additional MSK body area by TD, RD, RME, or DD | $150.00 | $192.00 | $199.00 |
| IR exam for non-MSK body area by TD, RD, RME or DD | $150.00 | $192.00 | $199.00 |
| Multiple IR exams by DD only (on request by DWC) | $50.00 | $64.00 | $66.00 |
| Extent-of-injury exam by RME or DD | $500.00 | $642.00 | $664.00 |
| Disability exam by RME or DD | $500.00 | $642.00 | $664.00 |
| Return-to-work exam by RME or DD | $500.00 | $642.00 | $664.00 |
| Other-similar-issues exam by RME or DD | $500.00 | $642.00 | $664.00 |
| Appropriateness of medical care by RME only | $500.00 | $642.00 | $664.00 |
| Missed appointment with DD only | does not apply | $100.00 | $104.00 |
| Specialist fee by DD only | does not apply | $300.00 | $311.00 |
| Review of another doctor's MMI/IR by TD only | $50.00 | $64.00 | $66.00 |