ProviderPulse
2012 Medical Fee Schedule
Billing/Administration
October 2011
On Sept. 30, 2011, the Division of Workers’ Compensation (DOWC) adopted changes to both Rule 16, Utilization Standards, and Rule 18, Medical Fee Schedule, that are effective on Jan. 1, 2012. The following is a brief summary of several sections that are revised for January 2012.
- For all medical services rendered after Jan. 1, 2012, please submit bills using the 2011 Current Procedural Terminology (CPT©), Professional Edition, published by the American Medical Association; the 2011 edition of the Relative Values for Physicians (RVP©); and the Medicare Severity Diagnosis Related Groups (MS-DRGs) Version 29.0, developed and published by 3M Health Information Systems using MS-DRGs effective after Oct.1, 2011.
- Rule 18-5(F)(2) contains changes, billing instruction and reimbursement information regarding drug testing.
- 18-5(G)(9) contains changes, billing instruction and reimbursement regarding Quantitative Sudomotor Axion Reflex Testing (QSART) and Autonomic Nervous System Testing.
- 18-5(G)(10) provides requirements for Intra-Operative Monitoring (IOM).
- 18-6(F)(4)(a) provides information regarding impairment ratings and medical records.
- 18-6(O)(1-8) contains new requirements for drugs and medications.
- 16-6(C) contains changes to payment processing when services are not identified in the fee schedule.
- 16-9(E) contains changes regarding prior authorization requirements.
For complete information on all changes and updates, please go to the DOWC website, access the Proposed/Adopted Rules/Notice of Rule Hearings section, and select the Rules of Procedure Including Medical Treatment Guidelines tab.
Impact of Spine Patient Outcomes Research Trial Results