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  •  Forms cannot be filed by email attachment or FAX; only original forms with original signatures are accepted.

  • Forms submitted must be current and as provided by the Commission.

  •  Altered, created/unauthorized or obsolete forms are not accepted. 

The forms and informational materials below are specific to the Maryland Workers' Compensation Commission Medical Fee Guide and the providers and payers of such services provided the injured worker in Maryland.  All forms/materials links utilize Adobe┬« Reader to view, complete and/or print these materials. 
   Visit www.adobe.com for more information on Adobe┬« Reader.

All questions regarding the MD WCC Medical Fee Schedule and medical claims should be sent via email: wccsupportserv@wcc.state.md.us or via telephone
(410) 864-5320; outside Baltimore Metro area toll free (800) 492-0479 selecting extension 5320 when prompted, during normal business hours. 
COMAR 14.09.01.31 establishes our hours of business: Monday -  Friday, 8:00 a.m. to 4:30 p.m., except legal holidays.

Claim for Medical Services
(WCC C-51, 3/2014)

Guide of Medical and Surgical Fees
COMAR 14.09.08 

Controversion Of Medical Claim 
(WCC H32, 4/2014)
 
 

Surgeon's Report WCC Form SF-2: Complete the online form (all fields require input) and submit it to the Workers' Compensation Commission by selecting the Submit button on the electronic form.  You may print/save the completed form after submission.  An email address is required to submit the form.  A receipt of form status is sent to the email address entered on the form.  All general information pertinent WCC WebForms on this page or other instructions included with specific forms are applicable.
Surgeon's Report WCC Form SF-2
Online Submission & Instructions
Surgeon's Report WCC Form SF-2
Printable PDF - posted 7/2011

The CMS-1500 Form version 02/2012 is required effective April 1, 2014
A CMS 1500 02/2012 paper form provided by commercial vendors (red ink/OCR) may be used.  No payer may refuse payment when a current, legible CMS 1500 form is submitted by a provider; handwritten forms may impact fulfillment by automated processes.
Sample CMS 1500 version 2/2012 (PDF)
http://www.nucc.org/images/stories/PDF/1500_claim_form_2012_02.pdf