Current
Workers' Compensation Hospital Discount Rates
Medical Regulations
39-71-704 MCA
The department develops, implements and monitors medical cost
containment strategies including fee schedules to reimburse
non-hospital providers, and discount factors used for reimbursing
hospital providers. Prior to January 1, 2008 the fee schedules held the increase in fees
payable to the increase in the average weekly wage each year,
and were adjusted on January 1 of each year. For non-hospital
payments the department used a nationally recognized relative
value fee schedule to determine the unit value of each procedure
performed and established the conversion factors to control
the amount paid. Currently, hospital rate increases are held down by the
use of discount factors, but are adjusted on July 1 by the average
weekly wage percentage change each year.
In 2007 the Montana legislature passed legislation directing the Dapartment to establish a Resource-Based Relative Value Scale (RBRVS) fee schedule for nonfacility medical services provided to injured workers.
This fee schedule applies to all nonfacility procedures and services provided on or after January 1, 2008.
Click here for the 2008 Montana Nonfacility Fee Schedule.
Update April 4, 2008
The reimbursement amount for CPT code 10021 is corrected to $223.98 (Non-Facility) and $121.19 (Facility)
The reimbursement amount for CPT code 10022 is corrected to $247.46 (Non-Facility) and $112.31 (Facility)
These corrected amounts are effective January 1, 2008
Previous Fee Schedules:
WC Medical Provider Categories, Related ARM & MCA, and Conversion Rates
As an aid to those calculating workers' compensation medical services reimbursement rates, the table below identifies by service provider category the related Montana statute or administrative rule section and the current conversion factor for service reimbursement. The RVP (Relative Values for Physicians) publication referenced here is produced by St. Anthony Publishing.
| Provider Category | MT Code Annotated (MCA) or Administrative Rules of Montana (ARM) 24.29.--- | NEW For dates of service on or after January 1, 2007 | For dates of service on or after January 1, 2006 |
| Acupuncture*** | 1541 & 1532(b)(i) | 5.85 | 5.59 |
| Anesthesia | 1566 & 1532(a) (ii) | 45.23 | 43.16 |
| Chiropractic | 1572 & 1532(v) | 5.51 | 5.26 |
| Dental*** | 1551 & 1532(b)(ii) | 11.35 | 10.83 |
| Medical | 1561 & 1532(a)(v) | 5.85 | 5.59 |
| Occupational Therapy | 1582 & 1532(b)(iii) | 5.51 | 5.26 |
| Pathology | 1532(a)(iv) | 21.06 | 20.10 |
| Physical Therapy | 1582 & 1532(b)(iv) | 5.51 | 5.26 |
| Radiology | 1532(a)(iii) | 24.28 | 23.17 |
| Surgery | 1532(a)(i) | 125.87 | 120.10 |
| Other* | 1532 ( c) | "...reasonable fees..." | "..reasonable fees..." |
| Prescription medicines | 1529 | January 1, 2007 - August 22, 2007: AWP plus $5.50 dispensing fee. Effective August 23, 2007: Brand name is the lesser of AWP minus 10% + $3.00 dispensing fee or price charged. Generic name is the lesser of AWP minus 25% + $3.00 dispensing fee or price charged. |
awp plus $5.50 dispensing fee |
| Non-hospital Medical equipment and supplies | 1521 | "...lesser of $30 or 30% above the cost of the item including freight... |
"...lesser of $30 or 30% above the cost of the item including freight... |
| Physical Medicine CPT Code 97750 | 1572 (6) & 1582 (6) | 31.81 per 15 Minute Unit | 30.36 per 15 Minute Unit |
* Administrative Rules of Montana (ARM) 24.29.1532 ( c):
"Relative values have not been developed for nurse
specialists, physicians assistants-certified,
optometrists, psychologists, licensed social
workers, or licensed professional counselors.
These providers must charge reasonable fees
for medical services."
***Use ARM Unit Value.
For further information, please email or phone us at (406)444-7732.
Medical
Regulations
Workers' Compensation Regulation Bureau
Employment Relations Division
PO Box 8011
Helena, MT 59604-8011
