The Medical Regulations Unit is responsible for publishing updates to the Montana Professional Fee Schedule and the various Montana Facility Fee Schedule components on the Department’s website. The unit is also responsible for developing, interpreting and implementing the numerous statutes and administrative rules that provide direction on how the fee schedules are administered. The Medical Regulations Unit maintains and updates the Montana Utilization and Treatment Guidelines (U & T Guidelines) and the web-based delivery system. The Department has hired a full time medical director, Dr. Carla Huitt, MD, MPH, who is a Board Certified Disability Specialist. The Medical Director conducts Independent Medical Reviews requested for denied services. The Medical Director presides over the updates to the U & T Guidelines and educates physicians in their use. The unit also serves as administrator for the Subsequent Injury Fund (SIF) which was developed to encourage employers to hire and retain injured workers. The Medical Regulations Unit is the liaison between the Department and those who have questions or need assistance with issues relating to the medical regulation of workers’ compensation claims in Montana.
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
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