UPDATE (July 1, 2014)
There will be a delay in the loading of the updated chapters of the Montana Utilization & Treatment Guidelines: Chronic Pain, Complex Regional Pain Syndrome, and Traumatic Brain Injury into the searchable web based platform. Beginning July 1, 2014, please begin using the PDF versions that can be found by going to the ERD Home page, and then to the Utilization and Treatment Guidelines page under “To view the three proposed updated utilization and treatment guideline…”
UPDATE (April 24, 2014)
Effective April 24, 2014, the Montana Employment Relations Division has published proposed updates to the Montana medical fee schedules, including both the Professional Fee Schedule and the Facility Fee Schedule, and the Montana Utilization and Treatment Guidelines.
A formal administrative rules process allows for public input and comment prior to adoption of the proposed fee schedules. On June 11, 2014, at 1:00 p.m., the Department will hold a public hearing in the Sanders Auditorium of the Department of Public Health and Human Services (DPHHS) Building, 111 North Sanders Street, Helena, Montana, to consider the proposed amendments to the rules. The public comment period is open until June 6, 2014.
To view the proposed fee schedules, please visit the related fee schedule page (see column at right).
To view the proposed administrative rules, please click the link below:
Proposed Changes to Montana Medical Fee Schedule Administrative Rules
Medical Regulations Unit
The Medical Regulations Unit is the primary liaison for the Department with providers, claims examiners and insurers who have questions, need assistance or require direction on all issues relating to the medical regulation of workers’ compensation claims, including medical fee schedules, utilization and treatment guidelines, and timely payments. The unit maintains and updates medical fee schedules for providers and payers and ensures access through a web based delivery system. The unit has a Medical Director, who is responsible for the maintenance, annual updates, distribution and training of the Montana Utilization and Treatment Guidelines. The Medical Director also performs independent medical reviews for denied services. The unit certifies injured workers for the Subsequent Injury Fund (SIF), applies the fee schedules to medical expenses, makes decisions on requested settlements as needed, manages the SIF fund balance, and authorizes payments for eligible SIF expenses.
Periodically the Department may post clarifications on the medical fee schedules. These can be located once the user has accepted the website usage permissions and logged into the site. See the Montana Facility Fee Schedule for the following clarification:
October 16, 2013: PT, ST, OT for outpatient hospital and Critical Access Hospitals
January 28, 2014: Professional Fee Schedule Clarification for DOS on or after July 1, 2013, Passive therapy vs passive modalities
Fee Schedule Adjustments Effective July 1, 2013
The new base rates for hospital inpatient, outpatient and ambulatory surgery centers were became effective July 1, 2013. New DRGS, APC, and CPT/HCPCS were added as well as new values. Also updated were various editing tables, status indicators, place of service codes and modifiers. A new Facility Fee Schedule Instruction Set is online for the convenience of users.
Type of Facility Base Rate
Inpatient Hospital $7,944.00
Outpatient Hospital $ 107.00
Ambulatory Surgery Ctr $ 80.00
The new conversion rate for the Professional Fee Schedule became effective July 1, 2013. The new conversion factor for anesthesia is $61.40. All other health services new conversation factor is $60.52. Also added to the Professional Fee Schedule were various editing tables, place of service codes and modifiers.
For further information, please email or phone us at (406) 444-6604.
Work Comp Claims Assistance Bureau
PO Box 8011
Helena, MT 59604-8011
Dr. Carla Huitt, MD, MPH
Tuesday, July 1, 2014