Provider Connection

2010 Coding Changes

Be sure that your coding staff is up to date regarding all 2010 coding changes. Some areas of interest with regard to workers’ compensation are:

  • Facet injection codes,
  • Neurostimulator (removal and revision) codes,
  • Prolonged time codes(99358 and 99359),
  • Excision codes.

Even though the Centers for Medicare & Medicaid Services (CMS) has decided to disallow most consultation codes, MSF will allow consultation codes as before.

Revised Prolonged Time Codes

(99358 and 99359)

99358 – first hour (must be a minimum of 30 minutes).

99359 – each additional 30 minutes.

  • No longer designated add-on.
  • Prolonged before and after direct face to face.
  • Time based –  must document total time spent.
  • Prolonged service time may be on a different date as long as it related to ongoing care and a service that has occurred or will occur (i.e., extensive record review).
  • Do not use for care plan oversight, team conference, online evaluation or anticoagulation management.

Massage Therapy – New Licensure

House Bill 662, the “Massage Therapy Licensing Act” will regulate the massage therapy profession and will become effective 7/1/10. Please see http://data.opi.mt.gov/bills/2009/billhtml/HB0662.htm for more information.

Codes billable to workers’ compensation for massage therapy are:

97124 – Massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion) each 15 minutes (each 15 minutes=1 unit). No more than three 15-minuteunits in one day can be billed without prior authorization. Time must be documented in the note (and should match the number of units billed on the CMS 1500 form).

97010 – Application of a modality to one or more areas; hot/cold packs. Services must be billed on a CMS 1500 form. Massage Therapy Providers must apply for NPI and taxonomy numbers prior to 7/1/10 as this information is required for reimbursement. If you have questions regarding filling out the CMS 1500 form, please call a member of the Medical Team.

For further information regarding the rules for Occupational and Physical Therapy specialty area in the ARM, visit the DLI website listed at the end of this Bulletin.

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Bill Status – 1-866-274-7464

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

RMS (Bill Status)
Phone  866-274-7464
Email customer.care@risingms.com

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


Medical Team

Michele Fairclough
Medical Team Leader
406-495-5362

Justin Kennedy
Nurse Manager
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

Sheryl Semans
Pharmacy Liaison
406-495-5010

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)