cannot be filed by email attachment or
FAX; only original forms with original
signatures are accepted.
submitted must be current and as
provided by the Commission.
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. Visitwww.adobe.comfor more information on AdobeReader.
All questions regarding the MD WCC
Medical Fee Schedule and medical
claims should be sent via email:
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
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
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.
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.