Section 12-15-85 - Rules for allowable fees for medical, surgical, and hospital services and supplies(a) Under no circumstances shall a provider of service directly charge the injured employee for treatments relating to the industrial injury.(b) When all the required care for a case reasonably falls within the range of qualifications of one physician, no other physician may claim a fee, except for consultation service or for surgical assistance. For groups of physicians or hospitals with satellite clinics, when service is rendered by a group member of the same specialty, the group shall submit bills as though one physician had cared for the patient.(c) Medical, surgical, or hospital care of an unusual type or unlisted fee may occur which represents a type of service over and beyond listed procedures. Appropriate fees may be allowed, subject to the employer's approval prior to the service being provided and after submission of a report to the employer containing at least the following information: (1) Diagnosis (post-operative);(2) Size, location, and number of lesions or procedures where appropriate;(3) Major surgical procedure and supplementary procedures;(4) Estimated follow-up period.(d) Medical conditions which are pre-existing or not resulting from the injury or occupational disease shall not be compensable. Palliative temporary treatment of unrelated conditions shall be allowed, provided these conditions directly retard, prevent, or endanger the surgical care or recovery from the compensable injury or illness. This treatment will cease as soon as it no longer exerts influence on the compensable condition. This shall be adequately explained in the physician's regular report.(e) Certain of the listed procedures are commonly carried out as an integral part of a total service and, as such, do not warrant a separate charge. When such a procedure is carried out as a separate procedure, not immediately related to other services, the indicated fee is applicable.(f) Minimal dressings, counseling incidental to treatment, etc., are covered by the office visit fee. Necessary drugs, supplies, and materials provided by the provider of service may be charged separately in accordance with section 12-15-55.(g) Fees, including office visits and rating examinations, shall not be paid for more than one visit per day by the same provider of service regardless of the number of industrial injuries or conditions treated.(h) Each provider of service shall certify on the bill or charges that such charges are in accordance with chapter 386, HRS, and any related rules.(i) Repeated failure to comply with chapter 386, HRS, and any related rules shall be a reasonable basis for an employer to refuse to pay or withhold payment for services rendered. The employer shall make payment within sixty calendar days of compliance with chapter 386, HRS, and related rules.[Eff 1/1/96] (Auth: HRS §§ 386-21, 386-72) (Imp: HRS § 386-21)