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

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)