Historical Fee Schedule Conversion Factors for 2003-2007
Pursuant to section 39-71-704 (4), MCA, and an administrative rules change to 24.29.1572, and 1582, ARM, on July 1, 2002, the Department adopted the following conversion factors, effective July 1, 2002, for use with the unit values listed in the Relative Values for Physicians or incorporated in the Medical Service Rules for workers' compensation services:
| |
January 1, 2003
|
Changes Eff 4/1/03
|
January 1, 2004
|
January 1, 2005
|
| Acupuncture |
5.09
|
-
|
5.24
|
5.42
|
| Anesthesia |
39.23
|
-
|
40.43
|
41.84
|
| Chiropractic |
4.85
|
4.79
|
4.93
|
5.10
|
| Dental |
9.85
|
-
|
10.15
|
10.50
|
| Medicine |
5.09
|
-
|
5.24
|
5.42
|
| Occupational Therapy |
4.85
|
4.79
|
4.93
|
5.10
|
| Pathology |
18.28
|
-
|
18.84
|
19.49
|
| Physical Therapy |
4.85
|
4.79
|
4.93
|
5.10
|
| Radiology |
21.07
|
-
|
21.71
|
22.46
|
| Surgery |
109.15
|
-
|
112.49
|
116.41
|
| Other |
|
|
|
"..Reasonable Fees" |
| Prescriptions |
|
|
|
awp plus 5.50
dispensing fee
|
| Medical Equipment and Supplies |
|
|
|
"…lesser of $30 or 30% above the cost of the item including freight" |
| CPT Code 97750 |
27.60 Per 15
Minute Unit
|
-
|
28.44 Per 15
Minute Unit
|
29.43 Per 15
Minute Unit
|
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.
All unit values, procedures codes and description, definitions, modifiers, ground rules, and instructions listed or incorporated by reference in the April 1, 1993, Medical Service Rules (with updates), the August 1, 1993, Chiropractic Service Rules, and the June 30, 2002, Physical Medicine Rules continue to apply.
For Historic details, see Montana Historic WC Medical Reimbursement Conversion Factors
Contacts
WC Medical Regulations Officer
