2016 Rules, Manual & Fees

The Health Care Services cost containment calculations for the 2016 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 2016 October release CMS Physicians Fee Schedule is the underlying data source for all the 2016 RBRVS based calculations.

Questions may be directed to 517-284-8900.

 

2016 HCS Rules 

 

2016 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 

 

 

 

          2017  HOSPITAL RATIOS

 

2017 Hospital Ratios

 

Methodology 

 

 

2016 Hospital Ratios

 

            RBRVS 

               Evaluation & Management; Medicine; Physical Medicine;

                Pathology; Radiology; Surgery

 

Worksheet 

 

Methodology