Updates For Your Health Care Services Rules And Manual-Effective January 11, 2002
The Health Care Services Rules have been amended adopting the 2002 CPT®
procedure codes. An update package will be mailed to those who purchased the
10/24/2000 rules and manual.
The following changes have been made to the health care services website:
The Health Care Services Rules contain all of the amended rules effective
January 11, 2002. The previous rules have been archived.
The Health Care Services Manual has been amended to include the January
11, 2002 rule changes.
Fee tables have been added for the new 2002 codes. All other CPT®
codes in the rules, effective 10/24/2000, will keep the same relative value
unit (RVU) and the maximum allowable payment is calculated by using the
conversion factor of $47.01 for medical, surgical and radiology services.
SUMMARY OF RULE CHANGES EFFECTIVE 1-11-02
Rule 107:
Update the source documents.
Relative values will be added for codes added in 2002.
Rule 115:
Language added to incorporate members of a Self-Insured Group Fund.
Rule 116:
Added language to clarify documentation that providers are required
to submit with the bill and what documentation the carriers must pay
for.
Rule 117:
Added language regarding 3% fee that carriers add a self-assessed
3% late fee when the properly submitted, bill is not paid within 30
days for a compensable injury.
Rule 212:
Removed language in subs 1 and 2 as the information is contained within
Physicians' Current Procedural Terminology (CPT®). Language added
that 97010 is not payable when billed with the E/M code (already in
rule 212-but should also be stated here. Re-worded the language regarding
after hour and weekend or holiday visits and put the information in
one sub rule. Also added information to clarify range of motion billed
with and office visit.
Rule 207:
Removed language that is duplicated in Physicians' Current Procedural
Terminology (CPT®).
This rule set deletes rules 405, 406, 407, 411, 415, 501, 502, and 503.These
rules contain billing instructions already found within Physicians' Current
Procedural Terminology (CPT®) adopted by reference, therefore the language
would be repetitive.
Rule 901:
Removes home health from the
rule. All other payers require home health to bill on the UB-92 claim
form. We have added rules 909 and 1005 to require billing home health
on the UB, standard with other payers. Payment for home health services
will remain BR or by report.
Rule 904:
Removed home health services. Additionally, we have removed modifiers
already listed in Physicians' Current Procedural Terminology (CPT®)
and Rule 418.10106 refers to use those instructions in CPT® as adopted
by reference in Rule 107.
Rule 909:
Instructs home health how to bill using the UB-92 form and codes found
in Medicare' Level HCPCS book as adopted by reference in Rule 107.
Rule 912:
Reworded the language regarding billing for prescription drugs.
Rule 916:
Added the EMG procedure codes to Table 10916. Practitioners will be
reimbursed the professional component of the procedure when performed
in an outpatient hospital setting. Currently the practitioner gets 100%
when performed in a facility just as in the office setting.
Rule 918:
Rule is rescinded. Physicians' Current Procedural Terminology (CPT®)
and RBRVS: The Physicians' Guide as adopted in Rule 107 already identifies
procedures having only a professional component. In addition some codes
on the table were incorrectly identified.
Rule 923:
Removed language in sub rule 2-a. This was incorrectly put in here
when the rules were re-organized and it changed the intent and meaning
of the rule. Also reworded subs 3 and 4 for clarity.
Rule 1002:
Changed the source document listed in sub 3a. The rule also corrects
a typo for the radiology conversion factor listed for year 2000. (The
fees listed in the manual used the correct conversion factor.)
Rule 1005:
Outlines reimbursement for home health services. Home health will
be billed on the UB-92, listing the procedure codes from Medicare Level
II HCPCS. Each home health procedure will be paid, as it is now, By
Report
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