BEFORE THE DEPARTMENT OF LABOR AND INDUSTRY

OF THE STATE OF MONTANA

 

In the matter of the amendment of ARM 24.29.1433, 24.29.1534, and 24.29.1538, related to workers' compensation medical service fee schedules

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NOTICE OF AMENDMENT

 

TO: All Concerned Persons

 

          1. On April 22, 2016, the Department of Labor and Industry (department)  published MAR Notice No. 24-29-314 pertaining to the public hearing on the proposed amendment of the above-stated rules at page 641 of the 2016 Montana Administrative Register, Issue Number 8. 

 

2.  On May 13, 2016, at 10:00 a.m., the department held a public hearing in the Second Floor Conference Room of the Beck Building, 1805 Prospect Avenue, Helena, Montana, to consider the proposed amendment of the above-stated rules. No members of the public commented on the proposed amendments at the public hearing, but members of the public commented during the rule comment period.

 

          3. The department has thoroughly considered the comments and testimony received. A summary of the comments received and the department's responses are as follows:

 

Comment 1:   A commenter noted that the professional fee schedule instruction set on page 8, pertaining to drug screens, and pages 8 and 9 of the facility fee schedule instruction set, pertaining to drug screens, were inconsistent.

 

Response 1: The commenter is correct. The professional fee schedule instruction set has been modified to conform to the facility fee schedule instruction set. The professional fee schedule instruction set language pertaining to drug screen will now read as follows (underlining and bold to be shown in the instruction set):

 

"Drug screens that are presumptive (screening and confirmation, qualitative or semi-quantitative) are billed using one of the three presumptive codes G0477-G0479.

          1. G0477 – Used to test any number of drug classes by any number of devices or procedures capable of being read by direct optical observation only (e.g. dipsticks, cups, cards, cartridges, etc. and includes sample validation when performed, per date of service.

          2. G0478 – Used to test any number of drug classes by any number of devices or procedures read by instrument-assisted direct optical observation (e.g. dipsticks, cups, cards, cartridges, etc.), and includes sample validation when performed, per date of service.

          3. G0479 – Used to test any number of drug classes by any number of devices or procedures by instrumented chemistry analyzers (e.g., immunoassay, enzyme assay, TOF, ALDI, LDTD, DESI, DART, GHPC, GC mass spectrometry), and includes sample validation when performed, per date of service. 

 

For drug screens that are definitive (quantitative) in nature and utilize drug identification methods able to identify individual drugs and distinguish between structural isomers (including but not limited to single or tandem GC/MS, single or tandem LC/MS (excluding immunoassay), any enzymatic method, etc.) are billed using the following tiers based on the number of drug classes tested, including

metabolite(s) if performed:

          1. G0480—1-7 drug classes

          2. G0481 – 8-14 drug classes

          3. G0482 – 15-21 drug classes

          4. G0483 – 22 or more drug classes

 

At maximum, only one code from each category (presumptive and definitive) is to be utilized per date of service or patient encounter resulting in no more than 2 billing codes per bill."

 

Comment 2:   A commenter noted that the professional fee schedule instruction set on page 15, pertaining to section 6 (pathology and laboratory) incorrectly referred to certain procedure codes not contained in the proposed fee schedule.

 

Response 2: The commenter is correct. The instruction set has been modified to conform to the fee schedule and reference the correct procedure codes.

 

Comment 3: A commenter identified an instance of a duplicated sentence in the facility fee schedule instruction set on page 10, pertaining to passive modalities.

 

Response 3: The commenter is correct. The instruction set has been modified to remove the duplicate sentence.

 

Comment 4: A commenter asked for clarification of the facility fee schedule instruction set, on pages 11 and 12, pertaining to inpatient (MS-DRG) reimbursements, inpatient implants, and the application of the outlier threshold.

 

Response 4: The department has modified the explanation of the treatment of requests for additional reimbursements when submitted under code MT003 to provide greater clarity.

 

Comment 5:   A commenter noted that the facility fee schedule instruction set on page 13, pertaining to outpatient reimbursement incorrectly refers to certain billing codes not contained in the proposed fee schedule.

 

Response 5: The commenter is correct. The instruction set has been modified to reference the correct billing codes.

 

Comment 6: A commenter requested that certain modifier codes found in subsection (j) of the facility fee schedule explicitly stated the amount of the allowed percentage of fees, as was provided in the 2015 facility fee schedule.

 

Response 6: Although the applicable percentage of fees is already identified in the RV-RVS, the department will add the percentage figures to applicable modifier codes as requested.

 

4. The department has amended the rules exactly as proposed.

 

 

 

/s/ MARK CADWALLADER          /s/ PAM BUCY

Mark Cadwallader                        Pam Bucy, Commissioner

Alternate Rule Reviewer              DEPARTMENT OF LABOR AND INDUSTRY

 

Certified to the Secretary of State June 6, 2016.