Provider Connection

Evaluation and Management – Time

When using time to support a level of service under Evaluation and Management, total time spent face to face with the patient must be documented along with documentation of what was included in the counseling and/or coordination of care.  Simply stating “45 minutes spent with more than 50% being counseling and coordinating care” is not sufficient to support a level 5 established patient visit if the documentation submitted does not otherwise support the service.  Per CPT “the extent of counseling and/or coordination of care must be documented in the medical record”.

Physical/Occupational Therapies
Rule of 8 and timed modalities – when more than 1 timed modality or therapeutic procedure is utilized during the same encounter, the total minutes spent is combined to determine the # of timed units that may be billed.  For example:  97110 – 8 minutes + 97140 – 9 minutes.  Total time is 17 minutes.  Using the table below, only 1 unit of service is billable:

8 – 22 minutes 1 unit
23 – 37 minutes 2 units
38 – 52 minutes 3 units
53 – 67 minutes 4 units

Time spent on untimed codes such as 97010 or 97014 would not be included in the total calculation as they are not designated as timed modalities although they would count toward the 8 units allowed per visit.

Remember:  A total of 8 units of active/passive therapeutic procedures per visit with these exceptions:

  • If active/passive therapeutic procedures are utilized:
    • only 2 units may be a passive modality per visit.
  • If only passive modalities and/or passive therapeutic procedures are being utilized, only 4 units may be billed per visit.

 

back to Provider Connection

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)