Tuesday, January 10, 2017 - 08:00am Categories:
Medical Provider News Archive

Effective January 1, 2017, WSI will implement the following fee schedule changes.  Click here to access the full fee schedules. 

  1. Ambulance Fee Schedule update is based on the CPI-U
    • Reimbursement increased by 1.0%
  2. Ambulatory Surgical 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 2.7% to $105.49
  3. Anesthesia Fee Schedule
    • Conversion factor increased 1.6% to $58.17
  4. Clinic Laboratory Fee Schedule is 250% of North Dakota’s Medicare Laboratory Fee Schedule
    • Presumptive drug screening codes should be billed with CPT codes 80305-80307
    • Definitive drug testing should continue to be billed with HCPC codes G0480-G0483
  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 Fee Schedule update is the Market Basket for Home Health services
    • Increase is 2.8% 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 2.69% to $9,150.00
    • The outlier threshold for 2017 is $80,500
  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
      • Including the new Physical Medicine Physical and Occupational Therapy evaluation codes
    • In following Medicare’s requirements, WSI will not recognize consult codes as valid codes.
    • Conversion factor increased by 1.6% to $68.19
  10. Outpatient Hospital Fee Schedule update is the Market Basket for hospital services
    • Conversion factor increased by 2.7% to $133.70
    • In following Medicare's requirements, WSI will no longer recognize the L1 modifier for outpatient lab charges. WSI will no longer issue separate payment for lab services that are unrelated to other outpatient services performed on that same day, even when ordered by a different physician.

If you have questions about this article, please send an email to wsipr@nd.gov.