(a) The Division
adopts the most recent version published prior to the date of service for the
following references Geographically Adjusted Resource Based Relative
Value Scale (RBRVS), as published by Optum 360, LLC, as authored by
the American Medical Association (AMA), insofar as it addresses medical matters
under the Act unless otherwise defined in this chapter and, the
Relative Values for Dentists (RVD), as published and authored
by Relative Value Studies, Inc., Thornton, Colorado, insofar as it addresses
dental matters under the Act.
(i) The Division
has determined that incorporation of the full text in these rules would be
cumbersome or inefficient given the length or nature of the rules;
(ii) The incorporation by reference does not
include any later amendments or editions of the incorporated matter beyond the
applicable date identified in subsection (a) of this section; and
(iii) The incorporated code, standard, rule
or regulation is maintained at 5221 Yellow stone Road, Cheyenne, WY 82002 and
is available for public inspection and copying at cost at the same
location.
(b) Each code
incorporated by reference in these rules is further identified as follows:
(i)
RBRVS, including gap
fill code values and
RVD, as they were in effect on the date
of service submitted, and adopted by the Department of Workforce Services,
Wyoming Workers' Compensation Division.
(ii) National Correct Coding Initiative
(NCCI) as they were in effect on January 1, of the year for the date of service
submitted, and adopted by the Department of Workforce Services, Wyoming
Workers' Compensation Division found at:
https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd.
(c) There are six (6) conversion
factors (CF) for the Professional Fee Schedule, Wyoming uses the National RBRVS
system and recognizes the below conversion factors:
SPECIALTY GROUP | CONVERSION FACTOR |
Anesthesia | $ 53.38 |
Spine Procedures | $ 77.49 |
Evaluation and Management | $ 37.84 |
Physical Med/Radiology/Surgery | $ 66.67 |
Radiology- MRI Services Only | $ 106.74 |
Dental | $ 55.73 |
(d)
Modifiers for Anesthesia and Surgical Assistants.
(i) Surgical Assistants.
(A) MD assistants shall be paid 20% of the
surgical allowance.
(B) Non-MD
assistants shall be paid 15% of the surgical allowance.
(ii) Anesthesia.
(A) All services are paid in accordance with
the Wyoming Fee Schedules in effect at the time that services are
rendered.
(B) At least one of the
following anesthesia modifiers must be submitted with each bill.
(C) Modifiers P1-P6 are suggested but not
required.
(D) AA-anesthesia
services performed by the Anesthesiologist, are paid at one hundred percent
(100%) of the allowable fees.
(E)
AD-medical supervision by a Physician with more than four (4) concurrent
anesthesia procedures are paid at fifty percent (50%) of the allowable
fees.
(F) QK-medical direction of
two (2), three (3) or four (4) concurrent anesthesia procedures involving
qualified individuals are paid at fifty percent (50%) of the allowable
fees.
(G) QX-qualified
non-physician anesthetists with medical direction by a Physician are paid at
fifty percent (50%) of the allowable fees.
(H) QY-medical direction of one qualified
non-physician Anesthetist by an Anesthesiologist are paid at fifty percent
(50%) of the allowable fees.
(I)
QZ-CRNA (Certified Registered Nurse Anesthetist) without medical direction by a
Physician are paid at one hundred percent (100%) of the allowable fees.
(e) Fees for
Independent Medical Evaluations (IME), Permanent Partial Impairment Ratings
(PPI), Medical Testimony and Deposition(s). See Chapter 10, and Chapter 9,
Section 1 for additional guidelines. Medical bills must indicate total time
spent on review of records, actual examination and writing of the report on the
written report and the CMS-1500 claim form. The medical report must include a
breakdown of the total time spent. Medical bills must also include time spent
on travel, if applicable.
(i) Independent
Medical Evaluations (IME) or Impairment Ratings. The Division shall pay
according to the following fee schedule:
(A)
If the IME or Impairment Rating is completed by the treating physician, use
Code 99455. If the IME or Impairment Rating is completed by a physician, other
than the treating healthcare provider, use Code 99456.
Code | Time | Payment |
99455-99456 | 1st
hour | $750.00 |
| Each additional 15 minutes | $93.75
|
(B)
Fees for No Call/No Show appointments, where a paper file review with report is
submitted to the Division will be paid in accordance with the above fee
schedule.
(C) Fees for No Call/No
Show appointments, where a paper file review with report is not completed or
submitted to the Division must be billed to the claimant.
(ii) Medical Testimony and Deposition
Charges. The Division shall pay according to the following fee schedule:
Code | Time | Payment |
99075 | 1st
hour | $750.00 |
| Each additional 15 minutes | $65.00
|