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Rule Title: PHYSICIAN FEES -- ANESTHESIA SPECIALTY AREA FOR SERVICES PROVIDED FROM APRIL 1, 1993, THROUGH DECEMBER 31, 2007
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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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24.29.1566    PHYSICIAN FEES -- ANESTHESIA SPECIALTY AREA FOR SERVICES PROVIDED FROM APRIL 1, 1993, THROUGH DECEMBER 31, 2007

(1) For services provided from April 1, 1993, through December 31, 2007, except as otherwise provided by this rule, fees for the anesthesia medical specialty area are payable according to the values listed in Relative Values for Physicians. Special unit value rules listed in (4) and (5) are established for anesthesia. Those special unit value rules supersede the corresponding unit values listed in Relative Values for Physicians, and apply to all providers. A physician who furnishes other medical services in addition to anesthesia must use the fee schedule that applies to the services rendered.

(2) Nothing in this rule is to be construed so as to broaden the scope of a provider's practice. Each provider is to limit their services to those which can be performed within the limits and restrictions of the provider's professional licensure. Providers may only charge for services performed that are consistent with the scope of their practice and licensure.

(3) The conversion factor used depends on the date the service was rendered:

(a) Effective April 1, 1993, the conversion factor for anesthesia specialty area services is $28.97.

(b) Effective January 1, 1994, and each year annually thereafter, the conversion factor will increase in the manner specified by ARM 24.29.1536.

(4) Time values for anesthesia specialty area services are calculated according to the Value Guidelines given at the beginning of the RVP Surgery/Anesthesia section, except the extra minutes after multiples of 15 (or 10) may be assigned fractions of a whole unit. For example, a total anesthesia time of 2 hours 20 minutes would have a prorated unit value of 9.3 (9 units for the first 2 hours 15 minutes, and .3 units for the remaining 5 minutes).

(5) Fees for the following anesthesia specialty area services are calculated using basic values only and the addition of time units is not allowed:

(a) Pulmonary Function Testing, procedure codes 94000 through 94799.

(b) Therapeutic and diagnostic services, including nerve blocks, which includes the following codes: 20550, 31500, 36400, 36420, 36425, 36488, 36489, 36490, 36491, 36600, 36620, 36625, 36660, 62270, 62273, 62274, 62276, 62277, 62278, 62279, 62280, 62282, 62288, 62289, 64400, 64402, 64405, 64408, 64410, 64412, 64413, 64415, 64417, 64418, 64420, 64421, 66425, 64430, 64435, 64440, 64441, 64445, 64450, 64505, 64508, 64510, 64520, 64530, 64600, 64605, 64610, 64620, 64630, 64640, 64680, 92960, 93503, and any other procedure codes that RVP identifies as "not appropriate for time units".

History: 39-71-203, MCA; IMP, 39-71-704, MCA; NEW, 1993 MAR p. 404, Eff. 4/1/93; AMD, 1994 MAR p. 680, Eff. 4/1/94; AMD, 2007 MAR p. 1670, Eff. 10/26/07.)


 

 
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