WORKERS' COMPENSATION AND OCCUPATIONAL DISEASE

24.29.1203 METHODS THE DEPARTMENT WILL APPLY TO EVALUATE INFORMATION PROVIDED The department shall deny a petition for a lump-sum conversion of permanent total disability unless the worker demonstrates that the worker's ability to become financially self-sustaining is more probab…

24.29.1204 FURTHER STUDIES MAY BE REQUIRED (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-741, MCA History: NEW, 1985 MAR p. 1564, Eff. 10/18/85; AMD, 1998 MAR p. 2872, Eff. 11/1/98; REP, 2013 MAR p. 841, Eff. 5/24/13.

24.29.1401 INITIAL LIABILITY (REPEALED) (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-510, 39-71-704, 39-71-743, MCA History: Eff. 12/31/72; AMD, 1991 MAR p. 2622, Eff. 12/27/91; AMD, 2007 MAR p. 260, Eff. 2/23/07; REP, 2024 MAR p. 1066, Eff. 5/…

24.29.1401A DEFINITIONS As used in subchapters 14 and 15, the following definitions apply: "Acute care hospital" or "hospital" means a health care facility appropriately licensed by the Department of Public Health and Human Services that provides inpatient and outpatient medical …

24.29.1402 PAYMENT OF MEDICAL CLAIMS Payment of medical claims must be made in accordance with the schedule of facility and professional medical fees adopted by the department. Payment of medical claims must also be made in accordance with the utilization and treatment guidelines…

24.29.1403 SELECTION OF PHYSICIAN (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-203, 39-71-704, MCA History: Eff. 12/31/72; AMD, 1991 MAR p. 2622, Eff. 12/27/91; REP, 1993 MAR p. 404, Eff. 4/1/93.

24.29.1404 DISPUTED MEDICAL CLAIMS The following issues are considered to be disputes arising over the amount of a fee for medical services: amounts payable to medical providers, when benefits available directly to claimants are not an issue; access to medical records; timeliness…

24.29.1405 PHYSICIANS' REPORTS (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-203, 39-71-704, MCA History: Eff. 12/31/72; AMD, 1991 MAR p. 2622, Eff. 12/27/91; REP, 1993 MAR p. 404, Eff. 4/1/93.

24.29.1406 FACILITY BILLS Facility bills must be submitted on a UB04 when the injured worker is discharged from the facility or every 30 days. The providers and payers shall use, when possible, electronic billing for the billing and reimbursement process. It is the responsibility…

24.29.1407 PROSTHETIC APPLIANCES Claims for furnishing replacement or repair of prosthetic appliances shall be paid to orthotists or prosthetists, who have been certified by the American Board for Certification in Orthotics or Prosthetics, and whose services are performed in a ce…

24.29.1408 SUSPENSION ALLOWED An insurer may suspend compensation payments under 39-71-607 , MCA, for not more than 30 days pending the receipt of medical information, if: the insurer submits to the department a detailed written statement indicating that the insurer is having dif…

24.29.1409 TRAVEL EXPENSE REIMBURSEMENT Payment of travel expense is subject to the following: Claims for travel reimbursement must be submitted on a form provided by the insurer within 90 days of the date the expense was incurred. After 90 days, the insurer must make reimburseme…

24.29.1415 IMPAIRMENT RATING DISPUTE PROCEDURE (REPEALED) (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-711, MCA History: NEW, 1987 MAR p. 1985, Eff. 10/30/87; AMD, 1990 MAR p. 1004, Eff. 6/1/90; AMD, 1991 MAR p. 2622, Eff. 12/27/91; AMD, 2007 M…

24.29.1416 APPLICABILITY OF DATE OF INJURY, DATE OF SERVICE The amounts of the following types of payments are determined according to the specific department rates in effect on the date the medical service or services are provided, regardless of the date of injury: medical fees;…

24.29.1420 RELATIVE VALUE FEE SCHEDULE (REPEALED) Authorizing statute(s): 39-71-203 and 39-71-704, MCA, as amended by section 3 of Ch. 422 of Laws of 1985 Implementing statute(s): 39-71-704, MCA History: NEW, 1986 MAR p. 454, Eff. 4/1/86; REP, 1993 MAR p. 404, Eff. 4/1/93.

24.29.1425 RATES FOR HOSPITAL SERVICES PROVIDED PRIOR TO JULY 1, 1997 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 1987 MAR p. 2388, Eff. 1/1/88; AMD, 1991 MAR p. 2622, Eff. 12/27/91; AMD, 1998 MAR p. 759, Eff. 4/1/98; RE…

24.29.1426 HOSPITAL SERVICE RULES FOR SERVICES PROVIDED FROM APRIL 1, 1998, THROUGH DECEMBER 31, 2007 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 1998 MAR p. 759, Eff. 4/1/98; AMD, 2007 MAR p. 1670, Eff. 10/26/07; REP, 2…

24.29.1427 HOSPITAL SERVICE RULES FOR SERVICES PROVIDED FROM JANUARY 1, 2008, THROUGH NOVEMBER 30, 2008 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 2007 MAR p. 1670, Eff. 10/26/07; AMD, 2008 MAR p. 2490, Eff. 12/1/08; RE…

24.29.1428 HOSPITAL RATES FOR JULY 1, 1997, THROUGH JUNE 30, 1998 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 1998 MAR p. 759, Eff. 4/1/98; REP, 2018 MAR p. 2527, Eff. 1/1/19.

24.29.1430 HOSPITAL RATES FROM JULY 1, 1998, THROUGH JUNE 30, 2001 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 1998 MAR p. 759, Eff. 4/1/98; AMD, 2007 MAR p. 260, Eff. 2/23/07; AMD, 2008 MAR p. 2490, Eff. 12/1/08; REP, 2…

24.29.1431 HOSPITAL RATES FROM JULY 1, 2001, THROUGH NOVEMBER 30, 2008 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 2007 MAR p. 260, Eff. 2/23/07; AMD, 2008 MAR p. 2490, Eff. 12/1/08; REP, 2018 MAR p. 2527, Eff. 1/1/19.…

24.29.1432 FACILITY SERVICE RULES AND RATES FOR SERVICES PROVIDED FROM DECEMBER 1, 2008 THROUGH JUNE 30, 2013 (REPEALED) (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-203, 39-71-704, MCA History: NEW, 2008 MAR p. 2490, Eff. 12/1/08; AMD, 2013 MA…

24.29.1433 FACILITY SERVICE RULES AND RATES The department adopts the fee schedules provided by this rule to determine the reimbursement for medical services provided by a facility when a person is discharged on or after July 1, 2013. An insurer is obligated to pay the fee provid…

24.29.1501 PURPOSE (REPEALED) (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 1993 MAR p. 404, Eff. 4/1/93; AMD, 2011 MAR p. 1137, Eff. 6/24/11; REP, 2024 MAR p. 1066, Eff. 5/11/24.

24.29.1510 SELECTION OF PHYSICIAN FOR CLAIMS ARISING FROM JULY 1, 1993 THROUGH JUNE 30, 2013 (REPEALED) (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 1993 MAR p. 2809, Eff. 12/1/93; AMD, 2007 MAR p. 260, Eff. 2/23/07; AMD,…

24.29.1511 SELECTION OF PHYSICIAN FOR CLAIMS ARISING BEFORE JULY 1, 1993 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 1993 MAR p. 404, Eff. 4/1/93; AMD, 1993 MAR p. 2809, Eff. 12/1/93; REP, 2018 MAR p. 2527, Eff. 1/1/19.…

24.29.1512 SELECTION OF PHYSICIAN FOR CLAIMS ARISING ON OR AFTER JULY 1, 2013 Initial or repeated treatment in an emergency room or urgent care facility is not selection of a treating physician. The insurer must provide formal notification of the designated treating physician by …

24.29.1513 DOCUMENTATION REQUIREMENTS A treating physician or emergent or urgent care provider must provide the insurer the following documents within seven days of the first claim-related visit: initial report; medical status form; and treatment bill (CMS 1500). The treating phy…

24.29.1515 FUNCTIONAL IMPROVEMENT STATUS Functional improvement status must consist of objective medical findings of the claimant’s functional status, and document the effect of interventions (positive, neutral, or negative) on functional goals. The functional improvement status …

24.29.1517 PRIOR AUTHORIZATION FOR CERTAIN SERVICES (REPEALED) (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, 39-71-743, MCA History: NEW, 1993 MAR p. 404, Eff. 4/1/93; AMD, 2002 MAR p. 1758, Eff. 7/1/02; AMD, 2007 MAR p. 260, Eff. 2/23/07; …

24.29.1519 SECOND OPINIONS FOR SERVICES PROVIDED ON OR BEFORE JUNE 30, 2011 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 1993 MAR p. 404, Eff. 4/1/93; AMD, 2011 MAR p. 1137, Eff. 6/24/11; REP, 2018 MAR p. 2527, Eff. 1/1/1…

24.29.1521 MEDICAL EQUIPMENT AND SUPPLIES FOR DATES OF SERVICE BEFORE JANUARY 1, 2008 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 1993 MAR p. 404, Eff. 4/1/93; AMD, 2007 MAR p. 260, Eff. 2/23/07; AMD, 2007 MAR p. 1670, E…

24.29.1522 MEDICAL EQUIPMENT AND SUPPLIES PROVIDED BY A NONFACILITY FOR DATES OF SERVICE FROM JANUARY 1, 2008 THROUGH JUNE 30, 2013 (REPEALED) (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 2007 MAR p. 1670, Eff. 10/26/07; …

24.29.1523 MEDICAL EQUIPMENT AND SUPPLIES If the relative value unit is null or not listed on the fee schedule for durable medical equipment, reimbursement is the total of: item cost; shipping cost; and the lesser of $30 or 30% of the item cost. If a provider adds value to durabl…

24.29.1526 DISALLOWED PROCEDURES (REPEALED) (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 1993 MAR p. 404, Eff. 4/1/93; AMD, 2003 MAR p. 2870, Eff. 12/25/03; AMD, 2011 MAR p. 1137, Eff. 6/24/11; REP, 2024 MAR p. 1066, Eff.…

24.29.1529 PRESCRIPTION DRUGS FEE SCHEDULE In addition to the limitations on the payments for and dispensing of prescription drugs as set out by 39-71-727, MCA, the following apply: The reimbursement rate for prescription drugs is based upon the rate in effect on the date the dru…

24.29.1531 USE OF FEE SCHEDULES FOR SERVICES PROVIDED FROM APRIL 1, 1993 THROUGH JUNE 30, 2002 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 1993 MAR p. 404, Eff. 4/1/93; AMD, 1993 MAR p. 1659, Eff. 8/1/93; AMD, 2002 MAR p…

24.29.1532 USE OF FEE SCHEDULES FOR SERVICES PROVIDED FROM JULY 1, 2002, THROUGH DECEMBER 31, 2007 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 2002 MAR p. 1758, Eff. 7/1/02; AMD, 2007 MAR p. 1670, Eff. 10/26/07; REP, 201…

24.29.1533 NONFACILITY FEE SCHEDULE FOR SERVICES PROVIDED FROM JANUARY 1, 2008 THROUGH JUNE 30, 2013 (REPEALED) (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 2007 MAR p. 1670, Eff. 10/26/07; AMD, 2009 MAR p. 8, Eff. 1/16/0…

24.29.1534 PROFESSIONAL FEE SCHEDULE An insurer must pay the fee schedule or the billed charge, whichever is less, for a service provided within the state of Montana. The fee schedules are available online at the department's web site and are updated as soon as is reasonably feas…

24.29.1536 CONVERSION FACTORS--METHODOLOGY FOR SERVICES PROVIDED FROM APRIL 1, 1993, THROUGH DECEMBER 31, 2007 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 1993 MAR p. 404, Eff. 4/1/93; AMD, 1994 MAR p. 680, Eff. 4/1/94; …

24.29.1537 SPECIAL MONITORING AND ADJUSTMENT OF PHYSICAL MEDICINE FEES DURING THE PERIOD JULY 1, 2002 THROUGH DECEMBER 31, 2003 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 2002 MAR p. 1758, Eff. 7/1/02; REP, 2018 MAR p. …

24.29.1538 CONVERSION FACTORS The conversion factors established by the department for goods and services, other than anesthesia services are: $61.09 on or after July 1, 2025. Allpriorconversion factorsfor services provided starting July 1, 2013, are available on the department's…

24.29.1541 ACUPUNCTURE FEES FOR SERVICES PROVIDED FROM APRIL 1, 1993, THROUGH DECEMBER 31, 2007 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 1993 MAR p. 404, Eff. 4/1/93; AMD, 1994 MAR p. 680, Eff. 4/1/94; AMD, 2007 MAR p…

24.29.1551 DENTAL SPECIALTY AREA FEES FOR SERVICES PROVIDED FROM APRIL 1, 1993, THROUGH DECEMBER 31, 2007 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 1993 MAR p. 404, Eff. 4/1/93; AMD, 1994 MAR p. 680, Eff. 4/1/94; AMD, …

24.29.1561 PHYSICIAN FEES -- MEDICINE FOR SERVICES PROVIDED FROM APRIL 1, 1993, THROUGH DECEMBER 31, 2007 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 1993 MAR p. 404, Eff. 4/1/93; AMD, 1993 MAR p. 1659, Eff. 8/1/93; AMD,…