Connecticut Workers’ Compensation Fee Schedule Rates

The Connecticut workers’ compensation fee schedule sets the maximum amounts medical providers can be paid for treating a workplace injury. The Workers’ Compensation Commission publishes two main schedules: a practitioner schedule covering physicians and other licensed providers, and a separate Medicare-based schedule covering hospitals and ambulatory surgery centers. The current practitioner schedule took effect July 15, 2025.¹ Prescription drugs follow their own pricing formula.

How Practitioner Rates Are Set

Connecticut does not use the relative value unit system that many states use. The Commission surveys what Connecticut providers actually charge for each procedure, then caps the workers’ compensation payment at the 74th percentile — the level where 74% of providers charge less. Each service is identified by its standard five-digit Current Procedural Terminology (CPT) code, and the schedule publishes a maximum dollar amount for each code.²

The maximums adjust annually, with growth capped by the annual increase in the Consumer Price Index for All Urban Workers (CPI-U), as required by Public Act 93-228.²

The schedule applies to all medical services delivered under the Workers’ Compensation Act, Title 31, Chapter 568 of the Connecticut General Statutes. That reaches licensed physicians, surgeons, physical therapists, chiropractors, and podiatrists.²

Non-Physician Rates

Non-physician providers billing under the same CPT codes as physicians receive 70% of the physician rate, with physical medicine services excepted. The rate is tied to the licensure of the practitioner who actually performs the service, not the licensure of whoever submits the bill. So in a practice where a physician assistant or nurse practitioner delivers care under physician supervision, the insurer pays based on who did the work.²

Negotiated Rates

The schedule is a ceiling, not a floor. Providers and payers can sign written agreements for different rates, including discounted rates through preferred provider networks. Absent such an agreement, the published schedule governs.²

Hospital and Ambulatory Surgery Center Rates

Hospitals and ambulatory surgery centers (ASCs) follow a different formula based on Medicare rates. Under Section 31-294d(e), the WCC chairperson publishes these rates annually after consulting with employers, insurers, hospitals, and ASCs.³ The 2025 schedule, published in Memorandum No. 2024-10, uses these multipliers:

Hospital inpatient: 174% of the Medicare rate payable to that facility
Hospital outpatient and hospital-based ASC: 210% of the Medicare rate payable to that facility
Non-hospital-based ASC: 195% of the hospital-based outpatient Medicare rate in the same Core Based Statistical Area

Connecticut facilities therefore receive substantially more for a workers’ compensation case than they would for the same service billed to Medicare.⁴ These facility fees cover the technical side of care: operating room time, nursing, equipment, and supplies. The surgeon’s professional fee is billed separately under the practitioner schedule.

Hospitals and ASCs can also negotiate different rates directly with employers or insurers. If no negotiated agreement is in place, the Medicare-based formulas apply.³

Prescription Drug Reimbursement

Prescriptions follow a separate formula: the Average Wholesale Price (AWP) plus a dispensing fee. Brand-name drugs carry a $5.00 dispensing fee. Generics carry $8.00. The higher generic fee is a deliberate incentive to dispense lower-cost alternatives.

Over-the-counter medications dispensed directly in a provider’s office are reimbursed at the provider’s acquisition cost plus 30%. When a physician dispenses medication from their own office rather than writing a prescription, reimbursement is based on the lower of the National Drug Code (NDC) price for the original manufacturer’s product or a therapeutic equivalent. If the original manufacturer information is not provided, the insurer has discretion to select the NDC and associated AWP used to calculate the payment.

Connecticut’s general pharmacy law requires substitution of a generic equivalent unless the prescribing physician specifically indicates the brand is medically necessary. When a generic is available and no valid override exists, reimbursement may be limited to the generic price.

Balance Billing Is Prohibited

The fee schedule amount is the maximum payment for any authorized service, and providers who treat workers’ compensation patients accept those caps as a condition of payment. They cannot bill the injured worker for the difference between their usual charge and the schedule amount. Section 31-294d limits the employer’s financial liability to charges that prevail in the community for comparable treatment, and the regulation makes the published schedule the binding ceiling.² If a provider tries to collect the balance from the worker, the worker can raise the issue before the Commission.

Payment Deadlines and Interest

Insurers have 60 days from receiving proper documentation to pay a compensable medical bill. Past day 60, unpaid bills accrue interest at 1.5% per month. That penalty is automatic and does not require a separate hearing.

For the broader claim, Connecticut imposes steeper consequences. If the employer or insurer is at fault for unduly delaying payments, an administrative law judge can add 12% annual interest plus a reasonable attorney’s fee to the award. Payments that have not started within 35 days after the employee files a written notice of claim are presumed to be unduly delayed, unless the employer has filed a notice to contest the claim. Where a delay was not the employer’s fault, such as a delay caused by an appeal, the judge can still award interest at a lower rate the judge considers fair and reasonable.⁵

Choosing a Treating Physician

You can select your own attending physician after receiving initial treatment from an employer-designated doctor, if the employer has one. The treating physician must be licensed in Connecticut.⁶

One exception matters enough to call out. If the employer has a managed care plan approved by the WCC chairperson, you must use a provider in that plan’s network. Treatment outside an approved managed care program can lead an administrative law judge to suspend all workers’ compensation benefits, not just the medical bills but wage replacement as well.⁶ Check for an approved managed care plan before scheduling an appointment with your own doctor.

Disputing a Medical Bill

When an employer or insurer wants to challenge liability for a medical treatment, they file a Form 43, the Notice of Intention to Contest Employee’s Right to Compensation Benefits. When the dispute involves medical care, a copy must also go to the medical provider.⁷

If a bill is being denied or underpaid, request an informal hearing at the WCC district office handling your claim. Informal hearings are less formal than a trial and resolve many billing disputes without extensive proceedings. If the informal process doesn’t fix it, the case can proceed to a formal hearing before an administrative law judge, who can order payment and add interest for unjustified delays.

1
Connecticut Workers’ Compensation Commission. Memorandum No. 2025-03 – 2025 Official Connecticut Practitioner Fee Schedule
2
Cornell Law School. Connecticut Agencies Regulations 31-280-3 – Practitioner Fee Schedule
3
Justia. Connecticut Code 31-294d – Medical and Surgical Aid, Hospital, Ambulatory Surgical Center and Nursing Service
4
Connecticut Workers’ Compensation Commission. Memorandum No. 2024-10 – 2025 WCC Hospital and Ambulatory Surgical Center Fee Schedule
5
Justia. Connecticut Code 31-300 – Award as Judgment, Interest, Attorney Fee, Procedure on Discontinuance or Reduction
6
Connecticut Workers’ Compensation Commission. An Employee’s Pocket Guide to Connecticut Workers’ Compensation
7
Workers’ Compensation Commission. Notice of Intention to Contest Employee’s Right to Compensation Benefits – Form 43