Department of Labor & Industry Updates Fee Schedules (Aug 2017)
Effective 7/1/2017 DLI updated the Fee Schedules, Instruction Sets and rules for the Montana Professional Fee Schedule and the Montana Facility Fee Schedule. Highlights are:
Professional Fee Schedule
Drug Screen that are presumptive must now be billed under the following codes:
Drug Screens that are definitive must be billed under the following codes:
New Montana Only code MT009
MT009 may be billed when a designated treating provider recommends an onsite job evaluation with the injured worker because there are concerns regarding the injured workers’ safe return to the workplace. This recommendation must be made on the Medical Status Form. The job evaluation will be completed by a Certified Rehabilitation Consultant (CRC) through the MSF.
More information on these topics as well as the full 2017 Instruction Set can found at https://mtwcfeeschedule.optum.com/documentations/2017%20Professional%20Fee%20Schedule%20Instruction%20Set.pdf. If you have further questions, please contact Maralyn Lytle at DLI at 406-444-6604.
FACILTY FEE SCHEDULE
|Facility Type||Base Rate|
|Outpatient Hospital||$ 114.00|
|Ambulatory Surgery Center||$ 86.00|
Modifier L1 is no longer required when billing laboratory only services. Per Medicare directives, you would use type of bill 13X. The services will be paid according to the Status Indicator assigned to the laboratory code.
Drug screen codes will be the same as under the Montana Professional Instruction Set.
Status Indicators (SI)
J1 – provides a single payment for a primary service which will package some services within the payment.
J2 – this status indicator is primarily for comprehensive observation services that affect APC 8011. Some codes with the SI will refer back to J1.
Complexity Reimbursement – Under the J1 and J2 SI’s, when there are 2 or more CPT/HCPCS code, the 2017 Status Indicator J1 Code Ranking and 2017 Status Indicator J1 Complexity Adjustment tables will need to be used to determine whether a code qualifies for a complexity adjustment. Please review the instructions under the July 1, 2017 Instruction Set on pages 14 and 15.
See http://erd.dli.mt.gov/work-comp-claims/medical-regulations/montana-facility-fee-schedule under the Fee Schedule Instruction Set for July 1, 2017.
If you have questions, call Maralyn Lytle at DLI at 406-444-6604.