Updated Fee Schedule Effective January 1, 2016

Effective January 1, 2016, WSI implemented the following fee schedule changes.   

1. Ambulance fee schedule update is based on the CPI-U
   • Reimbursement increased by 0.1%
2. Ambulatory Surgery Center fee schedule update is the Market Basket for hospital services
   • ASCs billing for device-intensive procedures
   • Report a single line item charge that includes both the charges associated with the service and the implantable device.
   • WSI will reimburse for services in the Medicine Section of the AMA CPT® code set if listed on Medicare’s published list of covered ASC services.
   • Conversion factor increased by 2.4% to $102.72
3. Anesthesia fee schedule
   • Conversion factor increased 1.1% to $57.25
4. Clinical Laboratory fee schedule is 250% of North Dakota’s Medicare Laboratory fee schedule
5. Dental fee schedule reflects a consistent payment for providers in all locations
   • Usual & Customary (UCR) module at the 70th percentile will be used
6. Durable Medical Equipment fee schedule is 120% of North Dakota’s Medicare schedule
7. Home Health Care fee schedule update is the Market Basket for Home Health services
   • Increase is 2.3% rounded to the nearest 50 cents
8. Inpatient Hospital fee schedule update is a blended (operating and capital) Market Basket increases for hospital services with adjustments for anticipated DRG weight and coding changes
   • Market Basket base rate increased by 2.3% to $8,910.00
   • The outlier threshold for 2016 is $61,500
9. Medicine fee schedule uses the Resource Based Relative Values System (RBRVS) Relative Value Unit (RVU) established by CMS.  All services have a single conversion factor 
   • Includes fee schedules for Chiropractic, E&M, Pathology, Medicine, PT and OT, Radiology and Surgery codes
   • CPT code changes from the American Medical Association (AMA) have been adopted
   • In following Medicare’s requirements, WSI will not recognize consult codes as valid codes.
   • Conversion factor increased by 1.1% to $67.12
10. Outpatient Hospital fee schedule update is the Market Basket for hospital services
    • Conversion factor increased by 2.4% to $130.18

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