Medical Regulations

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.

Clarifications

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 $61.40All 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.

Contact Information

For further information, please email or phone us at (406) 444-6604.

Medical Regulations
Work Comp Claims Assistance Bureau
PO Box 8011
Helena, MT 59604-8011

Dr. Carla Huitt, MD, MPH
Medical Director
(406) 444-6543
chuitt@mt.gov

Maralyn Lytle
(406) 444-6604
mlytle@mt.gov

Tuesday, July 1, 2014

Related Links

 

 

Domiciliary Carehttp://erd.dli.mt.gov/work-comp-claims/medical-regulations/domiciliary-careDomiciliary Care
Electronic Access to Insurer Information for Medical Providershttp://erd.dli.mt.gov/work-comp-claims/medical-regulationsElectronic Access to Insurer Information for Medical Providershttp://erd.dli.mt.gov/work-comp-claims/data-management/electronic-prior-claims, Electronic Access to Insurer Information for Medical Providers
FAQs for Medical Providers http://erd.dli.mt.gov/work-comp-claims/medical-regulations/medical-Provider-faqFAQs for Medical Providers
HIPAA and Release of Workers' Compensation Informationhttp://erd.dli.mt.gov/work-comp-claims/medical-regulations/hipaa-release-of-work-comp-infoHIPAA and Release of Workers' Compensation Information
Meals, Lodging and Mileagehttp://erd.dli.mt.gov/work-comp-claims/medical-regulations/meals-lodging-and-mileageMeals, Lodging and Mileage
Medical Regulations Formshttp://erd.dli.mt.gov/work-comp-claims/medical-regulations/medical-regulations-unit-formsMedical Regulations Forms
Montana Facility Fee Schedulehttp://erd.dli.mt.gov/work-comp-claims/medical-regulations/montana-fee-scheduleMontana Facility Fee Schedulehttp://erd.dli.mt.gov/work-comp-claims/montana-facility-fee-schedule-notice, Montana Facility Fee Schedule
Montana Facility Fee Schedule Archiveshttp://erd.dli.mt.gov/work-comp-claims/medical-regulations/montana-facility-fee-schedule-archivesMontana Facility Fee Schedule Archives
Montana Professional Fee Schedulehttp://erd.dli.mt.gov/work-comp-claims/medical-regulations/-----Montana Professional Fee Schedulehttp://mtwcfeeschedule.ingenix.com/overview.aspx, Montana Professional Fee Schedule
Past Lodging Rateshttp://erd.dli.mt.gov/work-comp-claims/medical-regulations/past-lodging-ratesPast Lodging Rates
Subsequent Injury Fundhttp://erd.dli.mt.gov/work-comp-claims/medical-regulations/----Subsequent Injury Fundhttp://erd.dli.mt.gov/work-comp-regulations/subsequent-injury-fund/subsequent-injury-fund, Subsequent Injury Fund
Utilization and Treatment Guidelineshttp://erd.dli.mt.gov/work-comp-claims/medical-regulations/------Utilization and Treatment Guidelineshttp://deverd.dli.mt.gov/utilization-and-treatment-guidelines, Utilization and Treatment Guidelines

 
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