Provider Bulletin

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
Conversion Factor

Standard Anesthesia
$62.92 $65.98

Drug Screens

Drug Screen that are presumptive must now be billed under the following codes:

80305
80306
80307

Drug Screens that are definitive must be billed under the following codes:

G0481
G0482
G0483

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
Inpatient Hospital $8,201.00
Outpatient Hospital $   114.00
Ambulatory Surgery Center $     86.00

Laboratory Billing
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.

Bill Status – 1-877-591-8028

Main Phone Number 406-495-5000 or 800-332-6102

Main Fax  406-495-5020

Medical Team – 406-495-5011

Submit your Claims and/or Correspondence To
Montana State Fund
PO Box 4759
Helena, MT  59604

ACS (Bill Status)
Phone  888-208-2116
Email  MSFBillReviewInquiries@Conduent.com

For questions regarding
: Information in this bulletin, call 800-332-6102 and ask for a member of the Medical Team. Advanced Nurse Review, Kym Vonada at 406-495-5389.


Medical Team

Michele Fairclough
Medical Team Leader
406-495-5362

Judy Morgan
Nurse Manager
406-495-5277

Justin Kennedy
Medical Management Specialist
406-495-5417

Shannon Hadley
Provider Relations Specialist
406-495-5245

Kym Vonada
Medical Auditor
406-495-5389

Annalyn Stewart
Medical Payment Auditor
406-495-5367

Susan Bomar
Medical Payment Auditor
406-495-5271

Cindy Gallus
Medical Customer Service Liaison
406-495-5189

Sherri Sprenger
Medical Customer Service Liaison
406-495-5420

Shannon Mergenthaler
Medical Customer Service Liaison
406-495-5185

Maggie Pentecost
Medical Customer Service Liaison
406-495-5322

Jamie Statton
Medical Customer Service Liaison
406-495-5386

Website Information

Montana State Fund montanastatefund.com

Department of LaborDepartment of Labor and Industry (DLI) website.
The website includes the Facility and Non-Facility Fee Schedule information as well as the Administrative Rules of Montana (ARM) and the instruction set for the Non-Facility Fee Schedule. Historical fee schedule information can also be found on this website.

If you have questions regarding the fee schedules call 406-444-6530 and someone will direct you to a DLI representative. For NPI information click here National Plan and Provider Enumeration System (NPPES)