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DEPARTMENT OF LABOR & INDUSTRY - EMPLOYMENT RELATIONS
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Montana Professional Fee Schedule
Data Specification
As stated previously, the data can be viewed in three ways:
  1. You may download the entire fee schedule (all the codes in all the service categories).
  2. You may download all the codes in one service category.
  3. 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.

  1. 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.
  2. 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.
  3. 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 ARM (Administrative Rules of Montana) 24.29.1574, .1575, .1585, and .1586.
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)


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