Effective January 1, 2021, WSI will implement the fee schedule changes described below. WSI will publish a subsequent news article notification when the 2021 Fee Schedule files are available.
- Ambulance Fee Schedule
- Update is based on the CPI-U
- Reimbursement increased by 0.6%
- Ambulatory Surgical Center Fee Schedule
- Update is based on the Market Basket for hospital services
- 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 $117.58
- ASCs billing for device-intensive procedures must report a single line item charge, which includes the charges associated with both the service and device
- Anesthesia Fee Schedule
- Update is based on the same percentage increase applied to the Medical Provider Fee Schedule
- Conversion factor increased 3.0% to $66.87
- Clinic Laboratory Fee Schedule
- Payment is set at 250% of North Dakota’s Medicare Laboratory fee schedule
- Presumptive drug screening codes must be billed with CPT codes 80305, 80306, or 80307
- Definitive drug testing must be billed with HCPC codes G0480-G0483
- Dental Fee Schedule
- Payment is set using the Usual and Customary module of the Comprehensive Healthcare model database at the 70th percentile for the Fargo geographical area using the zip code 581xx
- Reflects a consistent payment for providers in all locations
- Durable Medical Equipment Fee Schedule
- Payment is set at 120% of North Dakota’s Medicare Fee Schedule
- Home Health Fee Schedule
- Update is based on the Market Basket for Home Health services
- Reimbursement increased by 2.3%
- Increase is rounded to the nearest 50 cents
- New Home Infusion Therapy (HIT) and existing HIT codes (HCPC “G” Codes) are under the DME fee schedule
- Inpatient Hospital Fee Schedule
- Update is a blended (operating and capital) Market Basket increase for hospital services, with adjustments made for anticipated DRG weight and coding changes
- Market Basket base rate increased by 2.3% to $10,160.00
- The outlier threshold for 2021 is $66,500
- Long Term Care Hospital (LTCH) Fee Schedule
- Fee Schedule is based on Diagnosis Related Groups (DRGs)
- Market Basket base rate is $227,000. With DRG weight changes, this will result in a 2.3% overall increase to payments
- The outlier threshold for 2021 is $140,000
- The LTCH fee schedule does not incorporate any new technology add-on payments
- Providers must bill LTCH charges upon discharge only. WSI will not reimburse bills submitted as an interim stay
- Medical Provider Fee Schedule
- Based on the Resource Based Relative Values System (RBRVS) Relative Value Unit (RVU) established by CMS
- All services have a single conversion factor, including 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
- WSI has adopted Medicare’s new criteria for E&M codes 99202-99215
- Conversion factor is $70.30. With the RVU weight changes, this will result in a 3.0% overall increase in payments
- Outpatient Hospital Fee Schedule
- Update is based on the Market Basket for hospital services
- Conversion factor increased by 2.4% to $158.39
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