DATE:

January 10, 2005

TO:

Interested Parties

FROM:

Health Care Services Division

The Health Care Service rule updates for 2005 are expected to be effective on or about February 9, 2005.  The rule changes for 2005 will do the following:

1.

Adopt 2005 CPT® and HCPCS for coding purposes. 

2.

Use 2004 RVU data and a conversion factor of $48.49 (1.5% increase).

3.

Create a payment methodology for the freestanding surgical outpatient facilities. Refer to R 418.10923B for billing instructions and R 418.101023 for reimbursement rules.

4.

Increase the copying charge to 45 cents per page, + $2.50 retrieval fee for each 15 minute period and the cost of mailing in R 418.10118.

5.

Change the following modifiers (R 418.10904):

a.

Anesthesiologist providing supervision or medical direction uses -QK (no longer SA).

b.

A physician assistant, nurse practitioner or advanced practice nurse will use -GF to describe services (no longer -AU or -AK).

6.

Language in R 418.10912 requires use of generic medication or documentation of medical necessity if brand is written for.

7.

Language changes R 418.101015 for facility reimbursement to clearly define what documentation is required for a properly submitted bill. In R 418.101016 language was added to clarity that our rules apply to Michigan licensed facilities.

8.

Increase threshold for when a carrier is required to provide professional review from $5,000 to $20,000 (R 418.101205).

9.

Create a broader fee schedule for the laboratory services. Lab procedures will be paid at 10% over Medicare, while the pathology services will continue to be paid by RBRVS. The lab and pathology codes will no longer be published in the rules but will be in the manual.

10.

Update several rules to reflect the department name change from CIS to DLEG and bureau of workers’ compensation to the workers’ compensation agency. Also to note the change of the HCFA 1500 to CMS 1500.

The health care rules, manual and fee schedules will be posted to the website when the effective date is known.  The 2005 updates are effective 7 days after filing the rule package with the secretary of state, and we currently believe that the package will be filed on 2/1/2005.  Unless that changes, the rules will be placed on the website sometime after 2/1/2005.