Provider Connection

Physical Medicine– Active/Passive

The number of Passive therapeutic procedures/modalities allowed when an active therapeutic procedure is billed was changed to 2 effective 7/1/16 for dates of service on or after 7/1/16. The total of 8 units/procedures/modalities did not change (of which only 2 may be passive) when an active therapeutic procedure is performed.

Services of less than 8 minutes when that is the only service performed during a visit is not billable. Time intervals are incremented in 15 minute units (base is 8 minutes):

8-22 minutes =  1 unit
23-37 minutes = 2 units
38-52 minutes = 3 units
53-67 minutes = 4 units, etc

  • When more than one service of a timed modality is performed in a single day, the total minutes of the service performed should be included in the patient record to substantiate the level of service. A total of 8 units of active and passive therapy may be billed per visit. If active therapy is being applied, only two units of a passive modality may be included in the 8 units.
  • Passive therapies (listed in U&T Guidelines) will be limited to 4 units per visit, if only passive therapy is being applied. Note: Only 2 units may be billed if active therapy is being applied.
  • All timed codes must have the time documented (in minutes) in the office notes submitted for each code billed for reimbursement. Time needs to be actual time spent in the activity, not time based on the description of the code.
  • Therapy codes billed must have part of body documented or it must be clearly identified in a flow sheet or other attached documentation. If the procedures are clearly documented in the notes, a flow sheet is unnecessary. If the notes do not support the procedures billed but refers to a flow sheet then the flow sheet must be attached.
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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)