On October 22nd, the Texas Division of Workers’ Compensation (DWC) held its final quarterly insurance carrier meeting of 2025, which Healthesystems attended to document key updates.

According to the DWC, the gabapentin/pregabalin audit initiated in late 2023 is nearing completion, with findings and an executive summary expected in early 2026. As opioid prescribing has decreased nationwide, there has been an increase in the use of other medications for the treatment of pain in workers’ comp, and considering recent news regarding the greater risks of cognitive impairment in high gabapentin use, the insights generated from this summary will be of great interest.

Regarding billing discrepancies for designated doctors, the DWC stated that providers are misapplying exam fees and modifiers and omitting assignment numbers, which can lead to denials. Carriers must still reimburse the correct maximum allowable amount. Additionally, carriers must include assignment numbers in both the treatment authorization field and field 23 of the CMS-1500 to support prior authorization and accurate state reporting.

On the subject of compliance enforcement, the DWC issued 26 consent orders involving death benefits in FY 2025, with 24 resulting from audits and two from complaints. Non-compliance rates ranged from 14% to 75%, with average penalties of $38,992.

As for catastrophic incident monitoring, the DWC is tracking six major incidents involving natural disasters, workplace violence, and industrial accidents that caused multiple injuries and fatalities. Carriers and employers are urged to strengthen response plans and coordinate with agencies to ensure timely claims and care.

The Commissioner concluded the meeting by encouraging stakeholders to share feedback on any recent changes and how they are affecting care delivery and compliance. A recording and presentation slides will be made available.