Michigan Workers Compensation Fee Schedule: Rates, Billing, and Updates

The Michigan workers’ compensation fee schedule is the set of maximum rates that healthcare providers can charge when they treat a work-related injury in Michigan. The Workers’ Disability Compensation Agency publishes it under MCL 418.315, updates it each year, and ties most rates to Medicare with Michigan-specific adjustments. For an injured worker, the practical effect is simple: the schedule caps what the provider gets paid, and the provider must accept that as payment in full.¹

How the Rates Are Calculated

For physician services, the maximum payment is a conversion factor multiplied by the relative value units (RVUs) assigned to the procedure. The RVUs come from Medicare’s Resource-Based Relative Value Scale, adjusted for Michigan geography by blending 60% of the Detroit-area figures with 40% of the figures for the rest of the state. That produces a single statewide index rather than separate regional prices.²

For 2025, the conversion factor for medicine, radiology, and surgical procedures is $49.08.² A provider receives either its usual and customary charge or the calculated maximum, whichever is less. A provider who normally bills below the cap simply gets the standard rate.¹

What Each Service Category Pays

Not every service uses the RVU formula. Different categories have their own methods, most of them pegged to Medicare at set multipliers:

Physician services, including office visits, surgeries, and radiology: the 2025 conversion factor of $49.08 multiplied by RBRVS relative value units.
Orthotics and prosthetics: Medicare rate plus 5%.
Durable medical equipment, supplies, and biologicals: Medicare rate plus 5%.
Ambulance services, both air and ground: Medicare rate multiplied by 1.40.
Laboratory procedures: Medicare rate multiplied by 110%.
Ambulatory surgery center and freestanding outpatient facility procedures: Medicare ASC rate multiplied by 1.30.
Hospital facility services: a maximum payment ratio methodology. When a carrier pays a properly submitted bill within 30 days, payment equals the hospital’s charges times its maximum payment ratio times 107%.

These formulas appear in the Health Care Services Rules at Michigan Administrative Code R 418.101002 through R 418.101023.² When a CPT or HCPCS code has no assigned fee or RVU, the service is treated as “by report,” and reimbursement is the provider’s usual and customary charge or a reasonable amount, whichever is less.³

Prescription Drug Reimbursement

Prescriptions follow their own rules. The baseline reimbursement for most medications is the average wholesale price (AWP) minus 10%, plus a dispensing fee of $5.50 for a generic prescription or $3.50 for a brand-name prescription. Only one dispensing fee is paid for a given drug within any 10-day period, and over-the-counter medications get no dispensing fee.³

Generic substitution is required. When a generic equivalent exists, the pharmacy must dispense it. A physician can write “Dispense as Written” only after the generic has been tried and found ineffective or caused adverse effects, and the physician has to document that medical necessity in the patient’s record.³

Repackaged drugs are reimbursed based on the original manufacturer’s National Drug Code, not the repackager’s, at AWP minus 10%. Custom compound topical medications are capped at $600 per prescription, and anything above that requires carrier review. If opioid treatment continues beyond 90 days after pain onset, the prescribing physician must submit a written report to the payer justifying continued use.³

You Should Not Receive a Bill

Workers’ compensation medical coverage in Michigan has no deductible and no copayment. A provider cannot bill you for any amount above the fee schedule maximum, and cannot bill you for amounts disputed through the carrier’s utilization review process. The provider must accept the scheduled payment as final.⁴

If a bill for treatment tied to your workplace injury shows up at your address, treat it as a problem to escalate. Contact your employer’s insurance carrier and the Workers’ Disability Compensation Agency. The rules put the difference between the provider’s charges and the maximum allowable payment on the provider, not on you.³

Who Picks the Doctor

MCL 418.315 requires the employer to furnish reasonable medical, surgical, and hospital services for a work injury, along with dental services, prosthetic limbs, eyeglasses, hearing devices, and other appliances needed to cure or relieve the effects of the injury. For the first 28 days of treatment, the employer or its carrier controls which provider you see. After 28 days, you can switch to a physician of your own choosing by notifying the employer of the doctor’s name and your intent to treat with them.¹

The employer or carrier can petition to object to your chosen physician, but has to show cause before a workers’ compensation magistrate. Unless the magistrate orders otherwise, your choice stands. One limitation to know: if attendant or nursing care is provided by a spouse, parent, sibling, or child, reimbursement is capped at 56 hours per week.¹

Billing and Payment Deadlines

Providers have to bill promptly, on the proper claim form, with any documentation the Health Care Services Rules require. Once the carrier receives a properly submitted bill, it has 30 days to pay. If the carrier misses that window, it owes a one-time self-assessed 3% late fee on the maximum allowable payment or the provider’s charge, whichever is less.³

Providers also face a one-year filing deadline. A carrier is not required to reimburse claims submitted more than one year after the date of service, with exceptions for litigated cases and situations involving subrogation.³

When a Bill Is Adjusted or Denied

If a carrier reduces or rejects a provider’s bill, the provider submits a written request for reconsideration within 60 days. The carrier then has 30 days to respond. If the carrier does not respond, or the provider disagrees with the response, the dispute can move to mediation through the Workers’ Disability Compensation Agency.³

Disputes can involve the medical appropriateness of a treatment, whether utilization was justified, whether a service was needed, or the cost of the service. All go through the application-for-hearing process. When the dispute has resulted in denied treatment for the injured worker, it gets expedited handling to avoid prolonged gaps in care. Parties can also submit disputes to arbitration or handle them as small claims if the requirements are met. If an award already requires the carrier to provide medical benefits, the carrier has to keep providing them until a magistrate, the appellate commission, or a court orders otherwise.⁵

Enforcement Against Excessive Charges

Under MCL 418.315(4), if a carrier determines that a provider charged excessively or required unjustified treatment, the provider loses its right to payment for the excessive portion and must return any fees already collected. The agency can review the records and bills of any provider the carrier flags as noncompliant.¹

By accepting payment through the workers’ compensation system, a provider is considered to have agreed to submit records for utilization review and to comply with agency decisions. Providers who submit false or misleading information face additional consequences under the statute. The agency director can also independently schedule a hearing to determine whether a provider is complying with the Health Care Services Rules, rather than waiting for a carrier complaint.⁵

Annual Updates

The statute requires the fee schedule to be revised each year, and updates go through Administrative Procedures Act rulemaking, with public notice and a comment period before new rates take effect. An advisory committee appointed by the director of the Workers’ Disability Compensation Agency helps set the maximum charge schedules.¹

The current rules manual, rate tables, and travel reimbursement information are published on the Michigan Department of Labor and Economic Opportunity’s website. Conversion factors, procedural rules, and specific rates can change with each annual revision, so providers, carriers, and workers checking a specific number should confirm it against the current year’s publication.⁶ Michigan reimburses mileage for medical travel as well, though the rate posted on the agency’s site has not been updated recently, so it is worth confirming the current figure with your carrier or the agency.⁷

1
Michigan Legislature. Michigan Compiled Laws 418.315 – Furnishing Medical Services
2
Michigan Department of Labor and Economic Opportunity. Health Care Services Rules
3
Michigan Department of Labor and Economic Opportunity. 2025 Health Care Services Manual
4
Michigan Department of Labor and Economic Opportunity. Michigan Administrative Code R 418.10105 – Balance Billing Amounts in Excess of Fees
5
Justia Law. Michigan Administrative Code R 418.101304
6
Michigan Department of Labor and Economic Opportunity. 2025 Rules Manual and Fees
7
Michigan Department of Labor and Economic Opportunity. Travel Reimbursement Rates