2017 Rules, Manual & Fees

The Health Care Services cost containment calculations for the 2017 Rule Set are posted below. The boxes below address the seven 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.

CPT only copyright 2016 American Medical Association. All rights reserved.

The five-character codes included in the Health Care Services Manual (Fee Schedule) are obtained from Current Procedural Terminology (CPT®), copyright 2016 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures.

The responsibility for the content of the Health Care Services Manual (Fee Schedule) is with WCA and no endorsement by the AMA is intended or should be implied.  The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in this product. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Any use of CPT outside of this product should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms.

CPT is a registered trademark of the American Medical Association.

The 2017 October release CMS Physicians Fee Schedule is the underlying data source for all the 2017 RBRVS based calculations.

Questions may be directed to 517-284-8900.

 

2017 HCS Rules 

 

2017 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 

 

 

 

 

             Air Ambulance

              Air ambulance; air ambulance mileage

 

Worksheet 

 

Methodology 

 

 

 

          2018  HOSPITAL RATIOS

 

2018 Hospital Ratios

 

Methodology 

 

 

2017 Hospital Ratios

 

            RBRVS 

               Evaluation & Management; Medicine; Physical Medicine;

                Pathology; Radiology; Surgery

 

Worksheet 

 

Methodology