Updated Fee Schedule Effective January 1, 2024

Effective January 1, 2024, WSI implemented the fee schedule changes described below.  WSI will publish a subsequent news article when the 2024 Fee Schedule files are available.

1. Ambulance Fee Schedule
   • Update is based on the CPI-U 
   • Reimbursement increased by 3% ​​​​​​​ 
2. 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 3.3% to $129.85
   • ASCs billing for device-intensive procedures must report a single line-item charge, which includes the charges associated with both the service and device
3. Anesthesia Fee Schedule
   • Update is based on the same percentage increase applied to the Medical Provider Fee Schedule
   • Conversion factor increased by 4.6% to $74.12
4. 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
5. 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
6. Durable Medical Equipment Fee Schedule 
   • Payment is set at 120% of North Dakota’s Medicare Fee Schedule
7. ​​​​​​​​​​​​Home Health Fee Schedule 
   • Update is based on the Market Basket for Home Health services
   • Reimbursement increased by 3.3% 
   • Increase is rounded to the nearest 50 cents 
   • Home Infusion Therapy (HIT) codes (HCPC “G” Codes) are under the DME fee schedule
8. 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 3.23% to $11,200.00 
   • The outlier threshold for 2024 is $85,000.00
9. Long Term Care Hospital (LTCH) Fee Schedule 
   • Fee Schedule is based on Diagnosis Related Groups (DRGs) 
   • Market Basket base rate increased by 3.5% to $250,940.00  
   • The outlier threshold for 2024 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.  
10. 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.
    • Conversion factor increased by 4.6% to $77.94  
11. ​​​​​​​Outpatient Hospital Fee Schedule 
    • Update is based on the Market Basket for hospital services 
    • Conversion factor increased by 3.3% to $174.93 
    • WSI will continue to allow procedures moved from Medicare’s Inpatient Only List in 2021 to be completed in an outpatient setting. ​​​​​​

If you have questions about this article, please send an email to wsipr@nd.gov.  To receive provider news, subscribe to our Email Updates list.