On July 3, 2025, Governor Tony Evers signed Wisconsin’s biennial budget bill into law, which includes provisions to establish a new hospital fee schedule for workers’ compensation claims. The law establishes Wis. Stat. § 102.423, which directs the Department of Workforce Development (DWD) to develop and implement a fee schedule for hospital services provided under workers’ compensation claims.
Key Features of the Fee Schedule
The new bill requires the DWD to establish the fee schedule by July 1, 2027. Once finalized, the DWD will publish a notice in the Wisconsin Administrative Register, and the schedule will apply to medical services rendered after the publication date.
Fee Schedule Methodology
The fee schedule will be established in the following manner:
- Geographic Division: Wisconsin will be segmented into five regions based on economic and geographic similarity.
- Benchmark Pricing: For each region, the DWD will determine the 75th percentile of commercial in-network rates for each medical item or service. Medicare and Medicaid rates are excluded.
- Maximum Allowable Charge: The capped reimbursement is set at 120% of the 75th percentile commercial in-network price.
- Annual Updates: The schedule will be revised annually using updated commercial health insurance pricing data.
Payment Timelines and Compliance
The fee schedule will include strict payment deadlines based on the size of the medical bill to ensure timely reimbursement:
- Hospital bills under $65,000 must be paid within 60 days of receiving the bill or accompanying medical records, whichever is later.
- Hospital bills of $65,000 or more must be paid within 90 days under the same conditions.
If these deadlines are missed, hospitals are no longer bound by the fee schedule and may charge their full, undiscounted rates.
However, insurers may request a 30-day extension from the DWD if the compensability of the claim is still under review. Each extension, subject to DWD approval, is limited to 30 days, but there is no limit on the number of extensions granted. If an extension is denied, payment must be made within 14 days of the denial.
Scope of Application
The fee schedule applies only to “eligible hospitals” that meet the statutory definition in Wis. Stat. §§ 50.33(2) and 50.38(1). These include general hospitals that provide laboratory, diagnostic, surgical, or medical treatment services.
The definition excludes:
- Mental health institutions
- Psychiatric-only facilities
- Standalone clinics such as chiropractic, physical therapy, or pain management offices, unless they meet the hospital definition
Additional Key Provisions
- Balance Billing Prohibited: Hospitals may not pursue collection from injured workers for amounts above the scheduled rate.
- No Admission of Liability: Payment under the fee schedule does not constitute an admission of compensability or liability by the insurer or employer.
- Medical Records Requirement: Hospitals must provide substantiating medical records within 10 days of request, to the extent practicable.
Looking Ahead
Although the fee schedule is not yet in effect, employers, insurers, and claims administrators should begin preparing for its implementation:
- Review and update internal procedures to ensure compliance with the 60/90-day payment timelines.
- Track the DWD’s rulemaking and updates related to extension requests and implementation mechanisms.
- Review medical provider networks to identify which facilities qualify as hospitals under the statutory definitions and will be subject to the fee schedule for workers’ compensation claims.
Conclusion
The new hospital fee schedule represents a significant shift in Wisconsin’s approach to controlling worker’s compensation medical expenses. While implementation is still pending, early preparation will be critical to ensure compliance once the fee schedule becomes effective. Stakeholders should monitor the DWD’s progress and be ready to act once the fee schedule is formally published—no later than July 1, 2027.
