HB 627 caps all PIP medical reimbursement at Kentucky Workers' Compensation rates. Every CPT code. Every provider. Starting July 15, 2026. Policies opened before July 15, 2026 do not apply until renewed. This is the complete attorney guide — with real numbers.
Everything you need to know about the new law and how it affects your case.
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A concise guide to Kentucky’s new PIP law—fee caps, deadlines, and billing rules. Stay compliant and protect your clients.
Medical Reimbursement Rate Before: Providers billed "usual and customary" — whatever they charged. No ceiling. PIP presumed every bill reasonable. After: Capped at KRS 342.035 Workers' Comp MARs. Presumption of reasonableness survives, but capped at WC rates. Burden shifts to insurer to prove unreasonableness within the cap.
Balance Billing Before: Providers could bill PIP, then pursue the patient for the balance above what PIP paid. After: Prohibited. Providers cannot collect above the MAR from patients, cannot send balances to collections, and cannot impair patient credit for unpaid amounts.
Submission Deadline Before: No hard deadline. Late billing disputes handled case-by-case. After: 180 days from date of service. Bills submitted late risk complete non-payment. One exception: charges submitted via PIP arbitration under KRS 304.39-241.
$500/week wage loss maximum (roughly 51% of KY's 2026 average). Funeral benefits increased to $5,000, closer to actual costs and meaningful in wrongful death cases. Strategically allocate the $10K cap with this in mind.
The AG can now investigate and prosecute PIP fraud statewide.
Tort damages remain based on billed charges, not reduced PIP payments.
$10,000 PIP limit is unchanged. Only reimbursement rates are affected.
Services like MRI and chiropractic care now have maximum allowable reimbursements.
Access the latest Kentucky Workers' Compensation fee schedule rates.
These are the Maximum Allowable Reimbursement rates from the 2026 Kentucky Workers' Compensation Schedule of Fees for Physicians (803 KAR 25:089). Effective for policies renewed or initiated after July 15, 2026, PIP reimbursement cannot exceed these amounts.
The schedule is promulgated under KRS 342.035 and reviewed every two years. The law includes a floor: PIP cannot drop below the rate in effect on HB 627's effective date.
The MAR is the ceiling for PIP collection — Bills billed at MAR and paid at MAR are presumptively reasonable; bills billed above MAR are now presumptively unreasonable.
Source:Data Copyright 2026, FAIR Health, Inc. All rights reserved. Used with permission.
This is the most important distinction on the page. HB 627 caps what PIP pays providers. It does not cap the billed charge — and under Kentucky's collateral source rule, the billed charge remains the economic damages anchor in the tort claim.
Kentucky allows plaintiffs to present the full billed amount as evidence of economic damages — regardless of what was actually paid by PIP or any other source. HB 627 does not change this. The billed charge is still the number that drives settlement value and jury awards. What changes is what the provider collects from the no-fault carrier — a provider burden, not a plaintiff burden.
Your client's economic damages picture is built on billed charges — not WC MARs. The $10,000 PIP bucket now goes further because providers collect less from it per service, potentially leaving more available for wage loss and other PIP-covered expenses. The tort claim's medical specials are unaffected. Know both numbers: the MAR (what PIP paid) and the billed charge (what builds the demand).
This page is provided by miiSpine for general informational purposes only. It is not legal advice, does not create an attorney-client relationship, and should not be relied upon in evaluating or resolving any specific claim. miiSpine is a medical practice, not a law firm, and does not practice law.
HB 627 (2026 Acts Ch. 149) took effect July 15, 2026 and applies to policies issued or renewed on or after that date. Whether the new provisions govern a particular claim depends on the accident date, the policy term, and other case-specific facts. Attorneys should review the enrolled bill text and applicable regulations directly.
Reimbursement rates shown reflect the Kentucky Workers' Compensation Schedule of Fees for Physicians promulgated under KRS 342.035 (803 KAR 25:089). The schedule is reviewed biennially and rates are subject to change. Rates are reproduced for reference only and are not a quote, estimate, or guarantee of any charge or reimbursement amount.
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