Montana Professional Fee Schedule

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Montana Professional Fee Schedule
Data Specification

As stated previously, the data can be viewed in three ways:

You may download the entire fee schedule (all the codes in all the service categories).
You may download all the codes in one service category.
You may look up an individual code or code range.

Note that due to American Dental Association licensure users will need to log on when accessing the entire fee schedule or viewing the Dental codes only. This log on does not apply in other areas of the fee schedule.

These will now be explained in detail.

To download the entire fee schedule:
1. Select Treatment Year
2. Click "View Entire Fee Schedule"
3. You may open the information in an easy to read print friendly version, in a text file in a new window, save the information to your drive, or open in a .PDF document.
  This option will give you all of the data related information in the fee schedule table.
To download all the codes in one service category:
1. Select one service category
2. Click on "View Fee Schedule"
3. You may open the information in an easy to read print friendly version, in a text file in a new window, save the information to your drive, or open in a .PDF document.
To look up an individual code or code range:
1. Enter a single code(s) or range of codes. Acceptable formats include 5-digit alpha-numeric HCPCS Codes (case sensitive, first character must be upper case) or 5-digit CPT codes. An example for 5-digit CPTs:
  1. A single code(s), e.g.: 99213,A0425
  2. Code ranges, e.g.: 99211-99215 (no spaces). This output will give you codes 99211, 99212, 99213, 99214 and 99215.
2. Click on "View Fee Schedule"
3. You may open the information in an easy to read print friendly version, in a text file in a new window, or save the information to your drive.

Data Output and Layout

MTWCFEESCHED Table

This information is based off of a single table-driven system. It is provided in a fixed length text file for your convenience. Some notes on the data itself:

Each of the categories has a title to distinguish between one another:
      Category II and III =Temporary
      Anesthesia = Anesthesia
      HCPCS = HCPCS
      Etc...
Regarding the PC or -26 (Professional Component) and TC (Technical Component) modifiers in the Professional Type of Service Category: Where applicable, a "split" of the -26 and TC modifiers was used with the Total Fee. These modifiers always represent a percentage of the Total Fee.
Code descriptions are not available due to licensure restrictions.
The Modifiers' field for HCPCS Type of Service Category codes are: NU: New; UE: Used; RR: Rental.

MTWCFEESCHED Table Record Layout:

The following information may be useful for all formats.

Field Name	Max. Req. Field Length	Field Type	Field Description
Category	1 - 20	Char	Type of service category distinguisher.
Code	21 - 40	Varchar2	Code including CPT, HCPCS and Montana State Specific codes.
Modifier	41 - 60	Varchar2	Procedure code modifier
Professional Fee	61 - 80	Number	Total Professional Fee to two decimal places.
Facility Fee	81 - 100	Number	Total Facility Fee to two decimal places.
Gap Code	101 - 120	Varchar2	Gap Code Indicator
Mod 51 Exempt	121 - 140	Varchar2	Codes with the numeric unit 1 (one) and 2 (two) in this column are exempt from modifier 51
Add on	141 - 160	Varchar2	1 = code is considered an add-on code by the AMA 2 = code is considered an add-on code by the AMA and the code is exempt from use of Modifier 50. This modifier 50 status is assigned by Optum360 based on CPT guidelines.
Utilization Rules	161 - 195	Varchar2	Utilization and treatment rules in this column are based on 24.29.1611, and 24.29.1616.
Treatment Quarter	196 - 215	Varchar2	Quarter which code is implemented
Treatment Year	216 - 235	Varchar2	Year which code is implemented

Field type definition:

Char:	Character
Number:	Number
Varchar2:	Variable length character string (may have alpha, numeric and alpha-numeric characters)