Provider Connection

Physical Therapy Changes Effective 7/1/13

PTDOLI updated the physical therapy rules effective 7/1/13 with a few significant modifications. 

  • Rule of Eight:  When a service of less than 8 minutes is provided on a given day it is not billable.  CPT assigns codes per 15-minute increments but for purposes of “Rule of Eights” the following must be used:
    • 1 unit = 8-22 minutes
    • 2 units = 23-37 minutes
    • 3 units = 38-52 minutes, etc.

The actual therapy time spent must be documented by code within the note to support the modalities billed.

  • Passive/Active Therapy

Physical Rehabilitation Therapy is classified as passive and active therapies.  No more than 8 units of active and passive therapy may be billed per visit.  If any active therapy is used in a visit, only 1 unit of therapy may be a passive modality.  If more than one passive therapy is billed with an active modality the code with the lesser value will be denied.  If only passive therapy is used, then a total of 4 units of passive therapy may be billed. 

 

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)