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Effective January 1, 2019, WSI will implement the following fee schedule changes. Click here to access the full fee schedules.
- Ambulance fee schedule update is based on the CPI-U
- Reimbursement increased by 2.9%
- 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 2.9% to $111.48
- Anesthesia fee schedule
- Conversion factor increased 6.0% to $63.40
- 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, 80306 or 80307
- Definitive drug testing should continue to be billed with HCPC codes G0480-G0483
- Dental fee schedule reflects a consistent payment for providers in all locations
- Usual & Customary (UCR) module at the 70th percentile will be used
- Durable Medical Equipment fee schedule is 120% of North Dakota's Medicare schedule
- Home Health fee schedule update is the Market Basket for Home Health services
- Increase is 3.0% rounded to the nearest 50 cents
- 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 2.77% to $9,650.00
- The outlier threshold for 2018 is $77,500
- 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 6.3% to $73.81
- Outpatient Hospital fee schedule update is the Market Basket for hospital services
- Conversion factor increased by 2.9% to $150.17
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