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Rule: 24.29.1572 Prev     Up     Next    
Rule Title: CHIROPRACTIC FEES FOR SERVICES PROVIDED FROM JULY 1, 2002, 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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24.29.1572    CHIROPRACTIC FEES FOR SERVICES PROVIDED FROM JULY 1, 2002, THROUGH DECEMBER 31, 2007

(1) Effective July 1, 2002, through December 31, 2007, fees for services rendered by doctors of chiropractic are payable only for the procedure codes listed below and unless otherwise specified, are payable according to the unit values listed in the RVP. The procedure codes, descriptions, and unit values in the RVP apply to diagnostic x-rays for services provided by doctors of chiropractic.

(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 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) Except as provided by (6), the conversion factor used depends on the date the service was rendered:

(a) Effective July 1, 2002, the conversion factor for services performed by a doctor of chiropractic (other than diagnostic x-rays) within their scope of practice is set at $4.25 for services provided under (4)(a) and (b) below.

(b) Effective July 1, 2002, the conversion factor for services performed by a doctor of chiropractic (other than diagnostic x-rays) within their scope of practice is set at $4.25 for services provided under (4)(c) and (d) below.

(c) Effective July 1, 2002, the conversion factor for diagnostic x-rays performed by a doctor of chiropractic is set at $20.23.

(d) Beginning January 1, 2003, the conversion factor will be adjusted in the manner specified by ARM 24.29.1536.

(4) Only the following codes found in the RVP may be billed for chiropractic services:

(a) All physical medicine and rehabilitation codes except 97001 through 97006, 97033, and 97770 through 97781. Code 97799 may be billed only for providing the following services and requires a separate written report describing the service provided when billing for this code:

(i) face-to-face conferences with payor representative(s) to update the status of a patient upon request of the payor;

(ii) a report associated with nonphysician conferences required by the payor; or

(iii) completion of a job description or job analysis form requested by the payor.

(b) Special services, procedures and report codes 99070 and 99080. A separate written report must be submitted describing the service provided when billing for these codes.

(c) Chiropractic manipulative treatment codes 98940 through 98943.

(d) Evaluation and management codes 99201 through 99204 and 99211 through 99214.

(e) All diagnostic x-ray codes. The provider must furnish to the insurer documentation of the reasons justifying the use of the diagnostic x-ray procedure(s) employed.

(5) The explanations, protocols, comments and directions for use contained in both the CPT manual and the RVP to be applied to the procedure codes contained in this rule.

(6) Effective July 1, 2002, code 97750 is payable at $26.50 per 15-minute unit for a maximum of 24 15-minute increments of service per day. Beginning January 1, 2003, and each year annually thereafter, the amount payable per 15-minute unit for code 97750 shall increase by the percentage increase in the state's annual average weekly wage. If for any year the state's average weekly wage does not increase, the rate will be held at the existing level until there is a net increase in the state's average weekly wage.

(7) When chiropractors are performing orthotics fitting and training (code 97504) or checking for orthotic/prosthetic use (code 97703), supplies and materials provided may be billed separately for each visit using CPT code 99070.

History: 39-71-203, MCA; IMP, 39-71-704, MCA; NEW, 2002 MAR p. 1758, Eff. 7/1/02; AMD, 2007 MAR p. 1670, Eff. 10/26/07.


 

 
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