2014 Rules, Manual & Fees

The Health Care Services cost containment calculations for the 2014 Rule Set are posted below. The boxes below address the six different methods of calculation used to determine the maximum allowable payment (MAP) for medical care, treatment, procedures and devices under the Michigan Workers' Disability Compensation Act and the Health Care Services Rules.

Within each box, there are two buttons. Clicking on the worksheet button will take the user to a calculation worksheet where the appropriate CPT or HCPCS code is entered into the specific shaded box. Upon entering, the worksheet will automatically calculate the specific fee for the code. By clicking the methodology button, the user will be presented with a more detailed explanation of how the payment amount is calculated, and the specific rules governing these calculations.

The 2014 October release CMS Physicians Fee Schedule is the underlying data source for all the RBRVS based calculations.

Questions may be directed to 517-284-8900.

2014 HCS Rules 

 

2014 HCS Manual 

 

 

AMBULATORY SURGICAL CENTER

             Drugs & Biologicals, Pass-Through Items; Surgery

 

Worksheet 

 

Methodology 

 

 

 

ANESTHESIOLOGY

 

Worksheet 

 

Methodology 

 

 

 

CLINICAL LAB

 

Worksheet 

 

Methodology 

 

 

 

HCPCS LEVEL II

              Durable Medical Equipment; Orthotic/Prosthetic

 

Worksheet 

 

Methodology 

 

 

 

2015  HOSPITAL RATIOS

 

2015 Hospital Ratios

 

Methodology 

 

 

2014 Hospital Ratios

 

RBRVS 

               Evaluation & Management; Medicine; Physical Medicine;

                Pathology; Radiology; Surgery

 

Worksheet 

 

Methodology