Provider Connection

New Evaluation Codes for Physical Medicine

There are new Evaluation codes for Physical Therapy and Occupational Therapy that became effective 1/1/17:

Physical Therapy

97161 – Low complexity
97162 – Moderate complexity
97163 – High complexity
97164 – Reevaluation of physical therapy established plan of care

Occupational Therapy

97165 – Low complexity
97166 – Moderate complexity
97167 – High complexity
97168 – Reevaluation of occupational therapy established plan of care

Providers may continue to use the old codes (97001 – 97004) through June 30, 2017 and will be reimbursed at the current fee scheduled rate.   If your clinic/facility chooses to utilize the new codes, reimbursement will be in accordance with the Department of Labor & Industry (DLI) Administrative Rules of Montana (ARM) for situations where the code is not listed on the fee schedule.  The Montana Workers Compensation Fee Schedules are updated on an annual basis each July by DLI.


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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

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

Justin Kennedy
Nurse Manager

Shannon Hadley
Provider Relations Specialist

Kym Vonada
Medical Auditor

Annalyn Stewart
Medical Payment Auditor

Sheryl Semans
Pharmacy Liaison

Susan Bomar
Medical Payment Auditor

Cindy Gallus
Medical Customer Service Liaison

Sherri Sprenger
Medical Customer Service Liaison

Shannon Mergenthaler
Medical Customer Service Liaison

Maggie Pentecost
Medical Customer Service Liaison

Jamie Statton
Medical Customer Service Liaison

Website Information

Montana State Fund

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)