Legislative Update

On December 4, 2009, the Department of Labor & Industry (DLI) held a public hearing in Helena to consider amending Administrative Rules of Montana (ARM) 24.29.1533 and 24.29.1538. The proposed rule changes included:

1) 24.29.1533 (1)(a) the HCPCS codes, including CPT codes, which are incorporated by reference. Unless a special code or description is otherwise provided by rule, pursuant to 39-71-704, MCA, the edition of the CPT publication in effect at the time the medical service is furnished must be used to determine the proper procedure code and discussed in greater detail in (3);

2) 24.29.1533 (1)(b) the RVU given in the 2009  edition of the RBRVS which is incorporated by reference, unless a relative value is otherwise  specified in these rules. Unless a special code or description is otherwise provided by rule, pursuantto 39-71-704, MCA, the edition of the RBRVS in effect at the time the medical service is furnished must be used to determine the proper procedure code. For example, the 2010 version of the RBRVS applies to services provided from January 1, 2010 through December 31, 2010.

3) 24.29.1538 Conversion Factors for Services Provided on or after January 1, 2008 –Methodology: (2) proposed to add the following language for the conversion factor related to services other than anesthesia: If the department determines that a conversion factor does not need to change from theprevious year due to its analysis of the average in

(5), the most current factor listed below applies.

• No change to the conversion fartor for
  services other than anesthesia.

4) 24.29.1538 (3) proposed to add the following language for the conversion factor related to anesthesia services: If the department determines  that a conversion factor does not need to change from the previous year due to its analysis of the average in (5), the most current factor listed below applies.

• Changes the current conversion factor for anesthesia services to $60.97.

In a nutshell, DLI is proposing the Current Procedural Terminology (CPT) code and Resource-Based Relative Value Scale (RBRVS) in effect at the date of the service be used
for purposes of calculating the fee schedule. Please keep in mind there are Montana Only codes and values for some services.

There is no proposed change in the Standard Conversion Factor ($65.28) for 2010. The Anesthesia Conversion Factor has been adjusted to $60.97.