| Montana WORKERS COMPENSATION COLLECTION PUBLICATIONS AND INFORMATION FOR MEDICAL PROVIDERS |
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State Fee Schedule
Inpatient rehabilitation services are paid at 75%of the usual and customary charges
In Montana “usual and customary” means the provider’s normal charges for a service, and does not include state or
regional database information purporting to be usual and customary
Insurer payment is due within 30 days of receipt of the bill from the provider facility, or a 1% interest payment
penalty per month is charged
MS-DRG Calculations
• Each MS-DRG is given a Relative Weight based on its relative complexity and use of resources
• Montana’s Conversion Factor (CF) is $7,735 for the period beginning 12/01/08
• The payment formula is the Relative Weight multiplied by the CF ($7,735)
Inpatient Implant Reimbursement System
• Implants costing less than $10,000 are considered to be bundled into the MS-DRG reimbursement
• Implants costing more than $10,000 can be separately reimbursed at cost plus 15%
• Copies of Implant invoices are required for this separate reimbursement process
• Implant costs include shipping and handling
• Implant costs are excluded from outlier calculations
Outpatient Implant Reimbursement System
• Implants costing less than $500 are considered to be bundled into the APC reimbursement
• Implants costing more than $500* can, separately from the APC system, be reimbursed at cost plus 15 percent;
use Code L8699
• Copies of Implant invoices are required for this separate reimbursement process
• Implant costs include shipping and handling
* It is important to note that “implant cost” as used in the Montana WC system refers to the total implant costs
for all implants combined for a patient
Inpatient rehabilitation services are paid at 75%of the usual and customary charges
In Montana “usual and customary” means the provider’s normal charges for a service, and does not include state or
regional database information purporting to be usual and customary
Insurer payment is due within 30 days of receipt of the bill from the provider facility, or a 1% interest payment
penalty per month is charged
MS-DRG Calculations
• Each MS-DRG is given a Relative Weight based on its relative complexity and use of resources
• Montana’s Conversion Factor (CF) is $7,735 for the period beginning 12/01/08
• The payment formula is the Relative Weight multiplied by the CF ($7,735)
Inpatient Implant Reimbursement System
• Implants costing less than $10,000 are considered to be bundled into the MS-DRG reimbursement
• Implants costing more than $10,000 can be separately reimbursed at cost plus 15%
• Copies of Implant invoices are required for this separate reimbursement process
• Implant costs include shipping and handling
• Implant costs are excluded from outlier calculations
Outpatient Implant Reimbursement System
• Implants costing less than $500 are considered to be bundled into the APC reimbursement
• Implants costing more than $500* can, separately from the APC system, be reimbursed at cost plus 15 percent;
use Code L8699
• Copies of Implant invoices are required for this separate reimbursement process
• Implant costs include shipping and handling
* It is important to note that “implant cost” as used in the Montana WC system refers to the total implant costs
for all implants combined for a patient