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Rule Title: MEDICAL EQUIPMENT AND SUPPLIES FOR DATES OF SERVICE BEFORE JANUARY 1, 2008
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Department: LABOR AND INDUSTRY
Chapter: WORKERS' COMPENSATION AND OCCUPATIONAL DISEASE
Subchapter: Nonfacility Service Rules and Utilization Rules
 
Latest version of the adopted rule presented in Administrative Rules of Montana (ARM):

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24.29.1521    MEDICAL EQUIPMENT AND SUPPLIES FOR DATES OF SERVICE BEFORE JANUARY 1, 2008

(1) Reimbursement for medical equipment and supplies dispensed through a medical provider before January 1, 2008, is limited to a total amount that is determined by adding the cost of the item plus the freight cost plus the lesser of either $30.00 or 30 percent of the cost of the item, except prescription medicines are limited to charges allowed under 39-71-727, MCA. An invoice documenting the cost of the equipment or supply must be sent to the insurer upon the insurer's request.

(2) If a provider adds value to medical equipment or supplies (such as by complex assembly, modification, or special fabrication) then the provider may charge a reasonable fee for those services. Merely unpacking an item is not a "value-added" service. While extensive fitting of devices may be billed for, simple fitting (such as adjusting the height of crutches) is not billable.

(3) This rule does not apply to:

(a) equipment supply houses that are not also health care providers;

(b) hospitals; or

(c) pharmacies.

History: 39-71-203, MCA; IMP, 39-71-704, MCA; NEW, 1993 MAR p. 404, Eff. 4/1/93; AMD, 2007 MAR p. 260, Eff. 2/23/07; AMD, 2007 MAR p. 1670, Eff. 10/26/07.


 

 
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